Effectiveness of Carvedilol for Congestive Heart Failure that Developed Long after Modified Fontan Operation |
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Authors: | Naoko Ishibashi In-Sam Park Yukiko Takahashi Mitsunori Nishiyama Yasue Murakami Katsuhiko Mori Shigekazu Mimori Makoto Ando Yukihiro Takahashi Toshio Nakanishi |
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Institution: | (1) Department of Pediatrics and Cardiovascular Surgery, Sakakibara Heart Institute, Asahi-machi 3-16-1, Fuchu-shi, Tokyo, Japan;(2) Department of Pediatric Cardiology, Heart Institute of Japan, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku, Tokyo, Japan |
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Abstract: | We report a case of a patient with severe heart failure after Fontan procedure in whom carvedilol was very effective. A 27-year-old
man had intractable congestive heart failure due to severe ventricular dysfunction after Fontan operation. Central venous
pressure was elevated to 29 mmHg. A right-to-left shunt was noted across a large collateral vessel between the innominate
vein and the pulmonary vein. He was administered carvedilol (initial dose, 2 mg/day; maximum dose, 30 mg/day). Cardiac catheterization
performed 1 year after carvedilol administration revealed a decrease in atrial pressure and improvement of ventricular function.
He underwent a conversion operation to total cavopulmonary connection (TCPC) and ligation of a collateral vein communicating
with the innominate and pulmonary veins. Carvedilol may be a legitimate treatment before TCPC conversion or heart transplantation
for the high-risk group of patients with a failed Fontan circulation. |
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Keywords: | Carvedilol Fontan procedure Heart failure |
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