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Clinical Phenotypes of Fontan Failure: Implications for Management
Authors:Wendy M. Book MD  Jennifer Gerardin MD  Anita Saraf PhD  MD  Anne Marie Valente MD  Fred Rodriguez MD III
Affiliation:1. Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Ga, USA;2. Congenital Heart Center of Georgia, Atlanta, Ga, USA;3. Boston Adult Congenital Heart Disease and Pulmonary Hypertension Program, Harvard Medical School, Boston, Ma, USA;4. Department of Cardiology, Boston Children's Hospital, Boston, Ma, USA;5. Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Boston, Ma, USA;6. Department of Pediatrics, Emory University School of Medicine, Atlanta, Ga, USA;7. Sibley Heart Center, Atlanta, Ga, USA
Abstract:Fontan failure has been variably and inconsistently described in the literature, leading to challenges in comparing studies and evaluating treatments. Development of a conceptual framework to describe clinical phenotypes will aid in consistent terminology in the literature. In the heart failure literature, several key concepts have been described—“heart failure” is a clinical syndrome of various etiologies, with phenotype‐specific response to therapies. As the congenital heart disease community struggles to grapple with “Fontan failure,” these concepts come to light. Fontan failure in the context of four clinical phenotypes, including evaluation, potential management strategies, and future directions is discussed.
Keywords:Congenital Heart Disease  Fontan  Heart Failure  Cirrhosis  Portal Hypertension  Hemodynamics
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