Induction of aggressive arterial and venous dilation therapy in addition to pulmonary dilation therapy (super-Fontan strategy) improves Fontan circulation both at rest and during treadmill exerciseCentral MessagePerspective
Shoichi Ishikawa, MD,
Shun Matsumura, MD, PhD,
Akiko Yana, MD,
Clara Kurishima, MD,
Yoichi Iwamoto, MD, PhD,
Hirotaka Ishido, MD, PhD,
Satoshi Masutani, MD, PhD, FAHA,
Ryo Nakagawa, MD, PhD,
Hideaki Senzaki, MD, PhD, FAHA
Affiliations
Shoichi Ishikawa, MD
Department of Pediatrics, International University of Health and Welfare, School of Medicine, Chiba, Japan
Shun Matsumura, MD, PhD
Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan
Akiko Yana, MD
Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan
Clara Kurishima, MD
Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan
Yoichi Iwamoto, MD, PhD
Department of Pediatrics, International University of Health and Welfare, School of Medicine, Chiba, Japan; Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan
Hirotaka Ishido, MD, PhD
Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan
Satoshi Masutani, MD, PhD, FAHA
Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan
Ryo Nakagawa, MD, PhD
Department of Pediatrics, International University of Health and Welfare, School of Medicine, Chiba, Japan
Hideaki Senzaki, MD, PhD, FAHA
Department of Pediatrics, International University of Health and Welfare, School of Medicine, Chiba, Japan; Address for reprints: Hideaki Senzaki, MD, PhD, FAHA, Pediatric Community Medicine, Nihon Institute of Medical Science, CEO, Comprehensive Support Center for Children's Happy Life and Future Choko, Room 209, 1-14-1, Tohoku, Niiza, Saitama 352-0001, Japan.
Objective: Fontan circulation maintains preload and cardiac output by reducing venous capacitance and increasing central venous pressure (CVP). The resultant congestive end-organ damage affects patient prognosis. Therefore, a better circulatory management strategy to ameliorate organ congestion is required in patients with Fontan circulation. We sought to verify whether aggressive arterial and venous dilation therapy in addition to pulmonary dilation (super-Fontan strategy) can improve Fontan circulation and reduce congestion. Methods: Patients after Fontan surgery who received the super-Fontan strategy in a single center were recruited. Participants were examined using medical records between 2010 and 2018. We retrospectively analyzed the changes in hemodynamics at rest and during treadmill exercise before and after the introduction of this therapy. Results: The therapy significantly increased venous capacitance (3.21 ± 1.27 mL/kg/mm Hg to 3.79 ± 1.30 mL/kg/mm Hg, P = .017) and decreased total pulmonary resistance, leading to significantly reduced CVP (11.7 ± 2.4 mm Hg to 9.7 ± 2.2 mm Hg, P < .001) and increased cardiac index (CI) (3.09 ± 1.01 L/min/m2 to 3.54 ± 1.19 L/min/m2, P = .047). Furthermore, this strategy significantly reduced the elevations in CVP (19.6 ± 5.3 mm Hg to 15.4 ± 2.7 mm Hg, P = .002) with preserved CI in response to exercise. CVP at rest and during exercise was significantly positively correlated with serum markers of hepatic congestion and fibrosis, respectively. Conclusions: The super-Fontan strategy is a therapy that turns the heart failure condition of Fontan circulation into a more physiological condition. However, whether the strategy improves long-term prognosis warrants further studies.
