{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T11:00:26Z","timestamp":1775905226850,"version":"3.50.1"},"reference-count":15,"publisher":"Cambridge University Press (CUP)","issue":"5","license":[{"start":{"date-parts":[[2025,4,14]],"date-time":"2025-04-14T00:00:00Z","timestamp":1744588800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Cardiol Young"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Protein-losing enteropathy remains a formidable and underrecognised complication following Fontan surgery, contributing significantly to morbidity and mortality among affected patients. Despite substantial progress in managing single-ventricle CHDs, protein-losing enteropathy persists as a major clinical challenge, particularly in resource-constrained environments where specialised diagnostic modalities are scarce. This manuscript discusses the prevalence, clinical presentation, diagnostic hurdles, and management of protein-losing enteropathy in post-Fontan patients, drawing from clinical experiences in Vietnam. Among 95 post-Fontan patients reviewed, the prevalence of protein-losing enteropathy was 4.2%, with considerable morbidity necessitating invasive interventions and, in some cases, resulting in mortality. Diagnostic limitations, including restricted access to alpha-1-antitrypsin clearance testing, highlight the urgent need for heightened clinical suspicion and pragmatic diagnostic approaches. We advocate for integrating low-cost, widely accessible screening measures, such as routine serum protein monitoring, into standard post-Fontan care protocols to enhance early detection and management of protein-losing enteropathy. Furthermore, we underscore the critical importance of global collaboration and multicentre research initiatives to address the worldwide burden of protein-losing enteropathy, facilitate resource-sharing, and develop evidence-based interventions. Coordinated international efforts are essential to closing diagnostic and treatment gaps, ultimately improving survival and quality of life for patients living with the Fontan circulation.<\/jats:p>","DOI":"10.1017\/s1047951125001581","type":"journal-article","created":{"date-parts":[[2025,4,14]],"date-time":"2025-04-14T08:46:02Z","timestamp":1744620362000},"page":"1057-1061","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":0,"title":["Protein-losing enteropathy after fontan surgery: insights from Vietnamese clinical experience and the need for global collaboration"],"prefix":"10.1017","volume":"35","author":[{"given":"Dai Dac","family":"Tran","sequence":"first","affiliation":[{"name":"E Hospital"},{"name":"E Hospital"},{"name":"Vietnam National University"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tien Anh","family":"Do","sequence":"additional","affiliation":[{"name":"E Hospital"},{"name":"Vietnam National University"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Huy Quang","family":"Bui","sequence":"additional","affiliation":[{"name":"E Hospital"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thanh Ngoc","family":"Le","sequence":"additional","affiliation":[{"name":"E Hospital"},{"name":"Vietnam National University"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5992-875X","authenticated-orcid":false,"given":"Long Hoang","family":"Vo","sequence":"additional","affiliation":[{"name":"E Hospital"},{"name":"E Hospital"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2025,4,14]]},"reference":[{"key":"S1047951125001581_ref8","first-page":"37","article-title":"\u0110i\u1ec1u tr\u1ecb h\u1ed9i ch\u1ee9ng m\u1ea5t protein ru\u1ed9t sau ph\u1eabu thu\u1eadt fontan v\u1edbi ph\u01b0\u01a1ng ph\u00e1p m\u1edf c\u1eeda s\u1ed5 gi\u1eefa \u1ed1ng m\u1ea1ch nh\u00e2n t\u1ea1o v\u00e0 nh\u0129 ph\u1ea3i","volume":"3","author":"Anh","year":"2013","journal-title":"T\u1ea1p ch\u00ed Ph\u1eabu Thu\u1eadt Tim M\u1ea1ch v\u00e0 L\u1ed3ng Ng\u1ef1c"},{"key":"S1047951125001581_ref3","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.107.738559"},{"key":"S1047951125001581_ref4","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2014.04.025"},{"key":"S1047951125001581_ref12","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5223(96)70051-X"},{"key":"S1047951125001581_ref13","first-page":"100322","article-title":"Protein-losing enteropathy in fontan circulation: pathophysiology, outcome and treatment options of a complex condition","volume":"7","author":"Barracano","year":"2022","journal-title":"Int J Cardiol Congenit Heart Dis"},{"key":"S1047951125001581_ref9","first-page":"26","article-title":"B\u1ec7nh m\u1ea5t Protein qua \u0111\u01b0\u1eddng ru\u1ed9t sau ph\u1eabu thu\u1eadt Fontan","volume":"76","author":"H\u01b0\u01a1ng","year":"2014","journal-title":"H\u1ecdc L\u00e2m S\u00e0ng"},{"key":"S1047951125001581_ref10","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9149(01)02066-5"},{"key":"S1047951125001581_ref2","doi-asserted-by":"publisher","DOI":"10.1136\/thx.26.3.240"},{"key":"S1047951125001581_ref5","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5223(98)70406-4"},{"key":"S1047951125001581_ref7","doi-asserted-by":"publisher","DOI":"10.1111\/j.1747-0803.2007.00116.x"},{"key":"S1047951125001581_ref11","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2014.12.068"},{"key":"S1047951125001581_ref14","first-page":"100338","article-title":"Protein losing enteropathy after the fontan operation","volume":"7","author":"Alsaied","year":"2022","journal-title":"Int J Cardiol Congenit Heart Dis"},{"key":"S1047951125001581_ref1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.113.007764"},{"key":"S1047951125001581_ref6","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.03.582"},{"key":"S1047951125001581_ref15","doi-asserted-by":"publisher","DOI":"10.1177\/2150135117720685"}],"container-title":["Cardiology in the Young"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S1047951125001581","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T10:29:30Z","timestamp":1775903370000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S1047951125001581\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,14]]},"references-count":15,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2025,5]]}},"alternative-id":["S1047951125001581"],"URL":"https:\/\/doi.org\/10.1017\/s1047951125001581","relation":{},"ISSN":["1047-9511","1467-1107"],"issn-type":[{"value":"1047-9511","type":"print"},{"value":"1467-1107","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,14]]},"assertion":[{"value":"\u00a9 The Author(s), 2025. Published by Cambridge University Press","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}}]}}