Pediatric Cardiology

, Volume 35, Issue 4, pp 569–579 | Cite as

Beyond a Broken Heart: Circulatory Dysfunction in the Failing Fontan

  • Makoto Mori
  • Alfredo J. Aguirre
  • Robert W. Elder
  • Ali Kashkouli
  • Alton Brad Farris
  • Ryan M. Ford
  • Wendy M. Book
Review Article

Abstract

The role of ventricular dysfunction in late morbidity and mortality of univentricular hearts has been described previously. However, a significant proportion of adult Fontan patients who die or require heart transplantation do so with preserved ventricular function. The clinical deterioration in patients who have undergone Fontan palliation requires a broader view of circulatory dysfunction, one that takes into account the complex interaction of regulatory systems affecting hepatic, renal, and pulmonary blood flow, in addition to cardiac function. This review focuses primarily on the pathophysiology of multiple organ involvement in this circulatory dysfunction, with particular focus on the consequences of hepatic dysfunction and portal hypertension. The authors discuss hepatic perfusion, both in health and disease, and review the current understanding of liver histopathology and liver disease in adult Fontan patients and similar clinicopathologic states. They compare and contrast features of postsinusoidal portal hypertension with more typical adult cirrhotic disease. Finally, they delineate the related effects of portal hypertensive physiology on the systemic and pulmonary vasculature, the kidney, and the heart itself and discuss how these changes affect the care of the adult Fontan patient.

Keywords

Fontan Adult congenital heart disease Fontan failure Hepatic disease Portal hypertension 

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Makoto Mori
    • 1
  • Alfredo J. Aguirre
    • 1
  • Robert W. Elder
    • 2
  • Ali Kashkouli
    • 3
  • Alton Brad Farris
    • 4
  • Ryan M. Ford
    • 5
  • Wendy M. Book
    • 1
  1. 1.Division of CardiologyEmory University School of MedicineAtlantaUSA
  2. 2.Section of CardiologyYale University School of MedicineNew HavenUSA
  3. 3.Division of NephrologyEmory University School of MedicineAtlantaUSA
  4. 4.Department of PathologyEmory University School of MedicineAtlantaUSA
  5. 5.Transplant HepatologyEmory University School of MedicineAtlantaUSA

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