{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T18:29:39Z","timestamp":1787509779225,"version":"build-2736575974"},"reference-count":22,"publisher":"Cambridge University Press (CUP)","issue":"5","license":[{"start":{"date-parts":[[2020,4,6]],"date-time":"2020-04-06T00:00:00Z","timestamp":1586131200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cardiol Young"],"published-print":{"date-parts":[[2020,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Lymphopenia is common in adults who have had a Fontan operation although its aetiology and clinical implications remain unknown. Previous work suggests an association between lymphopenia and both liver disease and splenomegaly. The objective of this study was to assess the prevalence of lymphopenia in adults with a Fontan circulation and evaluate its associations with risk factors and clinical outcomes. Using a retrospective cohort study design, we studied 73 adult Fontan patients (age 25.0 \u00b1 8.4 years) who had a complete blood count and abdominal imaging performed. Patients with protein-losing enteropathy were excluded. Clinical data were extracted from hospital records. The mean white blood cell count was 6580 \u00b1 220\/ml with a mean lymphocyte count of 1223 \u00b1 508\/ml. Lymphopenia, defined as lymphocyte count &lt;1000\/ml, was present in 23 (32%) patients. Patients with lymphopenia had a lower total white blood cell count (5556 \u00b1 2517 versus 7136 \u00b1 1924\/ml, p = 0.009) and a lower platelet count (162 \u00b1 69 versus 208 \u00b1 69 k\/ml, p = 0.008). Lymphopenia was also associated with findings of portal hypertension, including splenomegaly (36 versus 14%, p = 0.04), varices (22 versus 6%, p = 0.04), and ascites (39 versus 14%, p = 0.02). Lymphopenia did not correlate with any cardiac imaging, haemodynamic or exercise testing variables. In conclusion, lymphopenia is common in adult Fontan patients and is associated with markers of portal hypertension. Larger studies are needed to better define the relationship between lymphopenia and clinical outcomes.<\/jats:p>","DOI":"10.1017\/s1047951120000694","type":"journal-article","created":{"date-parts":[[2020,4,6]],"date-time":"2020-04-06T03:05:03Z","timestamp":1586142303000},"page":"641-648","source":"Crossref","is-referenced-by-count":15,"title":["Lymphopenia in adults after the Fontan operation: prevalence and associations"],"prefix":"10.1017","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3777-4822","authenticated-orcid":false,"given":"Tarek","family":"Alsaied","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1683-5868","authenticated-orcid":false,"given":"Mathias","family":"Possner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Brown","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hassan","family":"Almeneisi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cassandra","family":"Szugye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew 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R.","family":"Opotowsky","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6401-9980","authenticated-orcid":false,"given":"Adam M.","family":"Lubert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2020,4,6]]},"reference":[{"key":"S1047951120000694_ref6","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2016-310108"},{"key":"S1047951120000694_ref21","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2014.08.010"},{"key":"S1047951120000694_ref14","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2013.12.046"},{"key":"S1047951120000694_ref11","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2013.06.008"},{"key":"S1047951120000694_ref20","first-page":"258","article-title":"The significance of neonatal thymectomy for shaping the immune system in children with congenital heart defects","volume":"14","author":"Stosio","year":"2017","journal-title":"Kardiochir Torakochirurgia Pol"},{"key":"S1047951120000694_ref5","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000696"},{"key":"S1047951120000694_ref7","first-page":"114","article-title":"Proposal for prevention or alleviation of Protein\/Lymph-Losing Enteropathy (PLE\/LLE) after Fontan circulation treatment of univentricular hearts: restoration of Lymph balance with a \u201cLymphatic Right-to-Left Shunt\u201d","volume":"49","author":"James","year":"2016","journal-title":"Lymphology"},{"key":"S1047951120000694_ref22","doi-asserted-by":"publisher","DOI":"10.1016\/j.jjcc.2016.04.001"},{"key":"S1047951120000694_ref15","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0b013e3181e52e69"},{"key":"S1047951120000694_ref2","doi-asserted-by":"crossref","first-page":"I157","DOI":"10.1161\/CIRCULATIONAHA.106.676445","article-title":"The Fontan procedure: contemporary techniques have improved long-term 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