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Effectiveness of carvedilol for congestive heart failure that developed long after modified Fontan operation

Naoko Ishibashi1, In-Sam Park, Yukiko Takahashi

  • 1Department of Pediatrics and Cardiovascular Surgery, Sakakibara Heart Institute, Asahi-machi 3-16-1, Fuchu-shi, Tokyo, Japan.

Pediatric Cardiology
|July 15, 2006
PubMed

Insights

Carvedilol effectively treated severe heart failure in a patient with a failed Fontan circulation. This beta-blocker improved ventricular function and reduced pressures, offering a potential treatment before surgical intervention.

Area of Science:

  • Cardiology
  • Pediatric Cardiology
  • Congenital Heart Disease

Background:

  • Fontan procedure is a palliative surgery for complex congenital heart defects.
  • Fontan-associated liver disease and heart failure are significant long-term complications.
  • Failed Fontan circulation presents a high-risk clinical scenario requiring advanced management strategies.

Observation:

  • A 27-year-old male presented with intractable congestive heart failure and elevated central venous pressure post-Fontan procedure.
  • A significant right-to-left shunt was identified via a collateral vessel.
  • The patient exhibited severe ventricular dysfunction, a common issue in Fontan failure.

Findings:

  • Administration of carvedilol (up to 30 mg/day) led to improved ventricular function and reduced atrial pressures.
  • Cardiac catheterization one year post-carvedilol initiation demonstrated these positive hemodynamic changes.
  • Surgical conversion to total cavopulmonary connection (TCPC) and collateral ligation were performed subsequently.

Implications:

  • Carvedilol may serve as a valuable medical therapy for patients with failed Fontan circulation awaiting surgical revision or heart transplantation.
  • This case highlights the potential role of beta-blockers in managing ventricular dysfunction in the Fontan population.
  • Further research is warranted to establish carvedilol's efficacy and safety profile in this specific patient group.

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