The Enigma of the Fontan circulationWolff, D., 2016, [Groningen]: Rijksuniversiteit Groningen. 247 p.
Research output: Thesis › Thesis fully internal (DIV) › Academic
Children who are born with a complex congenital heart disease, with only one well-developed ventricle and one underdeveloped or absent ventricle, usually require a surgical intervention at a young age. The Fontan procedure is designed to treat patients with this so-called functionally univentricular heart (one-chamber-heart) and who are not suitable for a biventricular (two-chamber) repair. The procedure results in a unique, unphysiologic circulation, in which only one ventricle sustains both the pulmonary and the circulatory circulation. Attrition of the Fontan circulation, most likely related to the unphysiologic characteristics, is an emerging problem currently faced by a growing cohort of patients. In this thesis, we demonstrated that the outcome after the Fontan operation has improved over the past decades. However, we also identified that the Fontan circulation is still associated with a multiple sequelae, including limited exercise tolerance, restricted cardiac and pulmonary function, and pulmonary vascular remodeling. Furthermore, with the help of a newly applied magnetic resonance technique, we recognized that the development of liver disease is far more common in Fontan patients than previously thought. Finally, we demonstrated that the surgical treatment for eventual failure of the circulation is associated with considerable mortality, and does not favor one surgical option above another. In conclusion, survival after the Fontan procedure has improved over the past decades, and the exercise tolerance, a biomarker called NT-proBNP and the development of liver disease may all be potential markers of Fontan attrition in the future.
|Qualification||Doctor of Philosophy|
|Place of Publication||[Groningen]|
|Publication status||Published - 2016|
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