{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T21:08:28Z","timestamp":1786741708965,"version":"build-2736575974"},"reference-count":17,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2020,4,9]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Recent studies suggest that lymphatic congestion plays a role in development of late Fontan complications, such as protein\u2010losing enteropathy. However, the role of the lymphatic circulation in early post\u2010Fontan outcomes is not well defined.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              This was a retrospective, single\u2010center study of patients undergoing first\u2010time Fontan completion from 2012 to 2017. The primary outcome was\n              <jats:italic>early Fontan complication<\/jats:italic>\n              \u22646\u00a0months after surgery, a composite of death, Fontan takedown, extracorporeal membrane oxygenation, chest tube drainage &gt;14\u00a0days, cardiac catheterization, readmission, or transplant. Complication causes were assigned to 1 of 4 groups: (1) Fontan circuit obstruction, (2) ventricular dysfunction or atrioventricular valve regurgitation, (3) persistent pleural effusions\n              <jats:italic>in the absence of<\/jats:italic>\n              Fontan obstruction or ventricular dysfunction, and (4) chylothorax or plastic bronchitis. T2\u2010weighted magnetic resonance imaging sequences were used to assess for lymphatic perfusion abnormality. The cohort consisted of 238 patients. Fifty\u2010eight (24%) developed early complications: 20 of 58 (34.5%) in group 1, 8 of 58 (14%) in group 2, 18 of 58 (31%) in group 3, and 12 of 58 (20%) in group 4. Preoperative T2 imaging was available for 126 (53%) patients. Patients with high\u2010grade lymphatic abnormalities had 6 times greater odds of developing early complications (\n              <jats:italic>P<\/jats:italic>\n              =0.001).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">There is substantial morbidity in the early post\u2010Fontan period. Half of those who developed early complications had lymphatic failure or persistent effusions unrelated to structural or functional abnormalities. Preoperative T2 imaging demonstrated that patients with higher\u2010grade lymphatic perfusion abnormalities were significantly more likely to develop early complications. This has implications for risk stratification and optimization of patients before Fontan palliation.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.119.015318","type":"journal-article","created":{"date-parts":[[2020,3,30]],"date-time":"2020-03-30T09:00:30Z","timestamp":1585558830000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":58,"title":["Prevalence and Cause of Early Fontan Complications: Does the Lymphatic Circulation Play a Role?"],"prefix":"10.1161","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4626-2829","authenticated-orcid":false,"given":"Reena M.","family":"Ghosh","sequence":"first","affiliation":[{"name":"Division of Cardiology Children\u2019s Hospital of Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather M.","family":"Griffis","sequence":"additional","affiliation":[{"name":"Center for Pediatric Clinical Effectiveness Children\u2019s Hospital of Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew C.","family":"Glatz","sequence":"additional","affiliation":[{"name":"Division of Cardiology Children\u2019s Hospital of Philadelphia PA"},{"name":"Center for Pediatric Clinical Effectiveness Children\u2019s Hospital of Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan J.","family":"Rome","sequence":"additional","affiliation":[{"name":"Division of Cardiology Children\u2019s Hospital of Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher L.","family":"Smith","sequence":"additional","affiliation":[{"name":"Division of Cardiology Children\u2019s Hospital of Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew J.","family":"Gillespie","sequence":"additional","affiliation":[{"name":"Division of Cardiology Children\u2019s Hospital of Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin K.","family":"Whitehead","sequence":"additional","affiliation":[{"name":"Division of Cardiology Children\u2019s Hospital of Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael L.","family":"O'Byrne","sequence":"additional","affiliation":[{"name":"Division of Cardiology Children\u2019s Hospital of Philadelphia PA"},{"name":"Center for Pediatric Clinical Effectiveness Children\u2019s Hospital of Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David M.","family":"Biko","sequence":"additional","affiliation":[{"name":"Department of Radiology Children\u2019s Hospital of Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chitra","family":"Ravishankar","sequence":"additional","affiliation":[{"name":"Division of Cardiology Children\u2019s Hospital of Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron G.","family":"Dewitt","sequence":"additional","affiliation":[{"name":"Division of Cardiac Critical Care Medicine Children\u2019s Hospital of Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoav","family":"Dori","sequence":"additional","affiliation":[{"name":"Division of Cardiology Children\u2019s Hospital of Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.115.306544"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2017.11.046"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1177\/2150135117720685"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.115.019710"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.13.11797"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2018.01.026"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezu015"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.113.007764"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2017.03.004"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2019180877"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2012.05.010"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCINTERVENTIONS.116.004924"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1111\/chd.12368"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1097\/00003246-200110001-00004"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezu022"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2012.12.042"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1126\/science.1243452"}],"container-title":["Journal 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