{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T21:33:45Z","timestamp":1793136825495,"version":"4.5.0"},"reference-count":37,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2026,6,16]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Patients born with single ventricle anatomy palliated with the Fontan procedure are at risk of lymphatic complications (LC), including plastic bronchitis, protein losing enteropathy, and ascites. The mechanism of LC, associated risk factors, and impact on end organ dysfunction and mortality are not well understood.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">We performed a single\u2010center, retrospective, cross\u2010sectional cohort study of patients with Fontan circulation seen at our center between 2009 and 2022. Univariate comparisons were completed comparing those with and without LC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      A total of 314 Fontan patients were included with a mean age of 20.2\u00b110.7\u2009years. Of those patients, 83 (26.4%) had at least 1 LC, including ascites (21.4%), protein losing enteropathy (11.8%), and plastic bronchitis (2.9%). Patients with LC were older (23.5\u00b112.6 versus 19.1\u00b19.8\u2009years,\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.001) and had their Fontan operation at an older age (5.5 with LC versus 4.0\u2009years without LC,\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.001). The presence of LC was associated with renal dysfunction (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.004), thromboembolism (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.01), and arrhythmia (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.001). LC were also associated with higher mean Fontan pressures on catheterization (14.7\u00b13.8 with LC versus 12.8\u00b13.7\u2009mm\u2009Hg without LC,\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.003). Fontan patients with LC had higher rates of transplantation (25.3% versus 2.2%,\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.001) and death (18.1% with LC versus 4.3% without LC,\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;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\">Fontan\u2010related lymphatic complications develop in 1 out of 4 patients by 20\u2009years of age, and they are associated with older age, renal dysfunction, thromboembolism, and arrhythmia. Patients with LC have higher rates of transplantation and death. Our findings indicate that elevated central venous pressure, rather than systolic cardiac or atrioventricular valve function, is associated with these complications.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.125.043310","type":"journal-article","created":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T11:49:12Z","timestamp":1781005752000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Fontan\u2010Related Lymphatic Complications: Incidence, Risk Factors, and Impact on Extracardiac Outcomes and Morbidity"],"prefix":"10.1161","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1180-7240","authenticated-orcid":false,"given":"Riley M.","family":"Boyd","sequence":"first","affiliation":[{"name":"Ann & Robert H. Lurie Children\u2019s Hospital of Chicago","place":["Chicago, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0336-3547","authenticated-orcid":false,"given":"Christina","family":"Laternser","sequence":"additional","affiliation":[{"name":"Ann & Robert H. Lurie Children\u2019s Hospital of Chicago","place":["Chicago, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5124-4935","authenticated-orcid":false,"given":"Karl","family":"Migally","sequence":"additional","affiliation":[{"name":"Ann & Robert H. Lurie Children\u2019s Hospital of Chicago","place":["Chicago, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9763-483X","authenticated-orcid":false,"given":"Shivani G.","family":"Patel","sequence":"additional","affiliation":[{"name":"Ann & Robert H. Lurie Children\u2019s Hospital of Chicago","place":["Chicago, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6695-8882","authenticated-orcid":false,"given":"Rima","family":"Dababneh","sequence":"additional","affiliation":[{"name":"Children\u2019s Heart Institute, Children\u2019s Memorial Hermann. McGovern Medical School","place":["Houston, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0345-0341","authenticated-orcid":false,"given":"Michael R.","family":"Carr","sequence":"additional","affiliation":[{"name":"Ann & Robert H. Lurie Children\u2019s Hospital of Chicago","place":["Chicago, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4257-1103","authenticated-orcid":false,"given":"Sheetal","family":"Patel","sequence":"additional","affiliation":[{"name":"Ann & Robert H. 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