Márquez-González H, Yáñez-Gutiérrez L, López-Gallegos D, Camargo-Zetina CO, Ortiz-Vázquez IC, Jiménez-Santos M, Santiago-Hernández JA, Ramírez-Reyes HA, Riera-Kinkel C

Language: Spanish
References: 11
Page: 163-168
PDF size: 209.21 Kb.

ABSTRACT

Background: Protein-losing enteropathy (PLE) is a known postoperative complication affecting about 10% of patients surgically managed with Fontan procedure. The mortality rate associated with this complication increases to 50%. Objective: To determine the risk factors associated to the development of PLE in patients surgically managed with Fontan procedure. Methods: This was a case-cohort study, and the universe of the trial comprised all patients treated with univentricular surgery. We included male and female patients with congenital heart disease that conditioned a single ventricle syndrome. Those patients with previous intestinal disease causing protein loss, were excluded, cow’s milk protein allergy, intestinal resection (previous or after heart surgery), use of cyclic parenteral nutrition or Fontan’s dismantlement. Follow-up began immediately after hospital discharge from Fontan procedure. Outcome variable was the development of PLE; independent variables were some before and after surgery hemodynamic and echocardiographic variables, infections and treatment. Statistical analysis: We used measures of statistical dispersion and central tendency. Risk was calculated for each variable estimating the hazard ratio (HR), adjusted for confounding factors; and Kaplan-Meier estimator was used for survival analysis. Results: Eleven (26%) out from patients 42 developed PLE. The median of time between Fontan procedure and the development of this complication was five years. The prognostic variables were: systolic pressure of pulmonary artery between 12-15 mmHg, › 3 years between Glenn and Fontan procedures, aggravated chronic malnutrition, direct bilirubin values › 1.5 mg/dL, pulmonary resistances (APR) between 3-3.5 Wood units, previous hepatomegaly and pleural effusion › 6 day-period. The probability of dying from PLE was 63% in a 10-year period. Conclusions: The prognostic factors associated with PLE are previous hepatic damage and borderlines values of venous pressure.

REFERENCES

1. Fontan F, Baudet E. Surgical repair of tricuspid atresia. Thorax. 1971; 6: 240-248.

2. Calderón-Colmenero J, Ramírez R, Viesca R, Ramírez L, Casanova M, García-Montes JA et al. Cirugía de Fontan. Factores de riesgo a corto y mediano plazo. Arch Cardiol Mex. 2005; 75: 425-434.

3. Cazzaniga M, Pineda LF, Villagrá F, Pérez de León L, Gómez R, Sánchez P et al. Operación modificada de Fontan o variantes efectuadas en un solo tiempo quirúrgico. Determinantes de la mortalidad. Rev Esp Cardiol. 2002; 55: 391-412.

4. Davidson JD, Waldman TA, Goodman DS, Gordon RS. Protein-losing gastroentero pathy in congestive heart failure. The Lancet. 1961; 1: 899-992.

5. Chakrabarti S, Keeton BR, Salmon AP, Vettukattil JJ. Acquired combined immunodeficiency associated with protein losing enteropathy complicating Fontan operation. Heart. 2003; 89: 1130-1131.

6. Laks H, Pearl JM, Haas GS, Drinkwater D, Milgater E, Jarmakani JM et al. Partial Fontan: advantages of an adjustable inter atrial communication. Ann Thorac Surg. 1991; 52: 1084-1095.

7. Senzaki H, Isoda T, Ishizawa A, Ishi T. Reconsideration of criteria for the Fontan operation. Influence of pulmonary size on postoperative hemodynamics of the Fontan operation. Circulation. 1994; 89: 1196-1102.

8. Rychik J, Gui-Yang S. Relation of mesenteric vascular resistance after Fontan operation and protein-losing enteropathy. Am J Cardiol. 2002; 90: 672-674.

9. Kiesewetter C, Sheron N, Vettukattill J, Hacking N, Stedman B, Millward-Sadler H. Hepatic changes in the failing Fontan circulation. Heart. 2007; 93: 579-584.

10. Orsi M, Fernández A, Follett F, Marchisone S, Saieg G, Busoni V et al. Alergia a la proteína de la leche de vaca. Propuesta de Guía para el manejo de los niños con alergia a la proteína de la leche de vaca. Arch Argent Pediatr. 2009; 107: 459-467.

11. Alberino F, Gatta A, Amodio P, Merkel C, Di Pascoli L,Boffo G, Caregaro L. Nutrition and survival in patients with liver cirrosis. Nutrition. 2001; 17: 445-450.