ABSTRACT
BACKGROUND: The effect of carvedilol on heart failure (HF) in patients with a functionally univentricular heart (UVH) remains unclear. METHODS AND RESULTS: Carvedilol was used to treat HF in 51 patients with a UVH, classified into 3 groups: after the Fontan operation (F), after the bidirectional Glenn operation (G), and patients who had not undergone Fontan or Glenn operation (NF). Carvedilol therapy was started at a mean age of 10 ± 12 years (range: 1 month to 34 years). The initial and maximum doses of carvedilol were 0.04 ± 0.03 and 0.42 ± 0.29 mg · kg(-1) · day(-1), respectively. After a mean follow-up of 11 months, the cardiothoracic ratio improved from 60 ± 8 to 58 ± 8% (P<0.01), and the dosage of furosemide was reduced from 1.4 ± 0.9 to 0.7 ± 0.7 mg · kg(-1) · day(-1) (P < 0.01). The ejection fraction also improved from 35 ± 12 to 40 ± 11% (P < 0.05), and this improvement was prominent in the F group (from 35 ± 15 to 45 ± 9%; P < 0.05). Clinical signs, symptoms, and New York Heart Association functional class also improved. CONCLUSIONS: Carvedilol may play an important role in treating HF associated with a UVH.
Subject(s)
Adrenergic alpha-1 Receptor Antagonists/therapeutic use , Carbazoles/therapeutic use , Heart Defects, Congenital/drug therapy , Heart Failure/drug therapy , Propanolamines/therapeutic use , Ventricular Function, Left/drug effects , Ventricular Function, Right/drug effects , Adolescent , Adult , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Anti-Arrhythmia Agents/therapeutic use , Carvedilol , Child , Child, Preschool , Drug Therapy, Combination , Female , Fontan Procedure/adverse effects , Heart Defects, Congenital/complications , Heart Defects, Congenital/physiopathology , Heart Defects, Congenital/surgery , Heart Failure/etiology , Heart Failure/physiopathology , Humans , Infant , Japan , Male , Recovery of Function , Retrospective Studies , Stroke Volume/drug effects , Time Factors , Treatment Outcome , Young AdultABSTRACT
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.
