Hemodynamic Characteristics After Fontan Procedure in Patients with Down’s Syndrome

• Published in: Pediatric cardiology Vol. 43; no. 2; pp. 360 - 365
• Main Authors: Otsuka, Masakazu, Kodama, Yoshihiko, Kuraoka, Ayako, Ishikawa, Yuichi, Nakamura, Makoto, Nakano, Toshihide, Kado, Hideaki, Umemoto, Shintaro, Ishikita, Ayako, Sakamoto, Ichiro, Ide, Tomomi, Tsutsui, Hiroyuki, Sagawa, Koichi
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-02-2022; Springer
• Subjects: Cardiac Surgery; Cardiology; Care and treatment; Central Venous Pressure; Child; Down Syndrome - complications; Fontan Procedure; Heart Defects, Congenital - surgery; Hemodynamics; Humans; Medicine; Medicine & Public Health; Original Article; Pulmonary hypertension; Retrospective Studies; Vascular Surgery; Venous pressure; Japan; Down’s syndrome; Central venous pressure; Fontan procedure; Pulmonary arterial hypertension-specific therapy
• ISSN: 0172-0643; 1432-1971
• DOI: 10.1007/s00246-021-02727-6

Patients with Down’s syndrome (DS) are generally regarded as not being good candidates for the Fontan procedure. However, detailed hemodynamic changes over time are not fully clarified. A retrospective chart review of all patients with DS who underwent the Fontan procedure and 5 times that number of Fontan patients without DS performed in Fukuoka Children’s Hospital and Kyushu University Hospital. Seven Fontan patients with DS were identified, and 35 Fontan patients without DS were recruited. During the mean observational periods of 14.7 years and 15.0 years (DS and non-DS, respectively) after the Fontan procedure, only one DS patient died. Central venous pressure (CVP) and transpulmonary pressure gradient significantly increased, and arterial oxygen saturation significantly decreased over time in DS patients after the Fontan procedure compared with those without DS. CVP in DS patients after the Fontan procedure increased over time compared with non-DS patients. Better management including the efficacy of Pulmonary arterial hypertension-specific therapy should be clarified in further studies.