title: Protein-losing enteropathy after the Fontan operation: successful treatment by percutaneous fenestration of the atrial septum.
abstract: Protein-losing enteropathy (PLE) after the Fontan operation is a life-threatening complication that may be refractory to medical therapy. Herein we describe a percutaneous atrial fenestration that was performed in a 42-year-old man with a double-inlet left ventricle who had undergone a Fontan operation 9 years earlier. Severe PLE developed, and despite frequent infusions of protein, his albumin level was 1.8 g/dL. The diagnosis of PLE was confirmed by an alpha(1)-antitrypsin clearance of 425 mL in 24 hours (normal 27 or less). Percutaneous atrial fenestration resulted in dramatic clinical improvement and resolution of the PLE. At 5-month follow-up, the patient's albumin level was 4.2 g/dL, his alpha(1)-antitrypsin clearance was normal, and he was free of ascites and edema.
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic Rochester, Minnesota 55905, USA.
authors.forename: C A
authors.initials: CA
authors.lastname: Warnes
authors.forename: R H
authors.initials: RH
authors.lastname: Feldt
authors.forename: D J
authors.initials: DJ
authors.lastname: Hagler
mesh_terms: D000328:Adult; D018729:Fontan Procedure / Q000009:adverse effects*; D006325:Heart Atria; D006346:Heart Septum / Q000601:surgery*; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000601:surgery*; D011504:Protein-Losing Enteropathies / Q000209:etiology / Q000378:metabolism / Q000601:surgery*; D012709:Serum Albumin / Q000378:metabolism
chemical_list: D012709:Serum Albumin