Effectiveness of carvedilol for congestive heart failure that developed long after modified Fontan operation.
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.
Ishibashi
Naoko
N
Department of Pediatrics and Cardiovascular Surgery, Sakakibara Heart Institute, Asahi-machi 3-16-1, Fuchu-shi, Tokyo, Japan.
Park
In-Sam
IS
Takahashi
Yukiko
Y
Nishiyama
Mitsunori
M
Murakami
Yasue
Y
Mori
Katsuhiko
K
Mimori
Shigekazu
S
Ando
Makoto
M
Takahashi
Yukihiro
Y
Nakanishi
Toshio
T
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D002227:Carbazoles / Q000627:therapeutic use*; D000077261:Carvedilol; D004621:Embolization, Therapeutic; D018729:Fontan Procedure / Q000009:adverse effects*; D018610:Heart Bypass, Right; D006333:Heart Failure / Q000188:drug therapy* / Q000209:etiology; D006345:Heart Septal Defects, Ventricular / Q000601:surgery; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000002:abnormalities / Q000601:surgery; D011412:Propanolamines / Q000627:therapeutic use*; D011666:Pulmonary Valve Stenosis / Q000601:surgery; D012086:Reoperation; D014188:Transposition of Great Vessels / Q000601:surgery; D018754:Ventricular Dysfunction / Q000150:complications / Q000628:therapy
D000319:Adrenergic beta-Antagonists; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol