{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T19:35:27Z","timestamp":1786649727541,"version":"build-2736575974"},"reference-count":7,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Feeding refusal is an uncommon and often overlooked manifestation of hemodynamic deterioration in patients with Fontan physiology.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Presentation:<\/jats:title>\n                    <jats:p>We report a child with trisomy 21 and unbalanced atrioventricular septal defect who presented several years after Fontan completion with progressive feeding refusal and ascites. Comprehensive evaluation revealed severe atrioventricular valve regurgitation without Fontan pathway obstruction. Medical optimization resulted in clinical improvement, and surgical valve repair was planned.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Feeding refusal may represent an early clinical clue of Fontan failure. Prompt recognition and multidisciplinary management are essential to optimize outcomes in this high-risk population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/heartviews.heartviews_133_25","type":"journal-article","created":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T05:00:14Z","timestamp":1776315614000},"page":"281-283","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Managing Feeding Refusal as an Unusual Presentation of Severe Atrioventricular Valve Regurgitation in a PostFontan Patient with Down Syndrome"],"prefix":"10.4103","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0821-4161","authenticated-orcid":false,"given":"Mohamed Metwally","family":"Abdelaal","sequence":"first","affiliation":[{"name":"Division of Pediatric Cardiology, Chest Disease Hospital, Kuwait"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mustafa","family":"Alqbandi","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology, Chest Disease Hospital, Kuwait"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,4,15]]},"reference":[{"key":"R1-20260416","first-page":"1135","article-title":"The Fontan procedure: Evolution in technique and outcomes","volume":"110","author":"Jacobs","year":"2020","journal-title":"Ann Thorac Surg"},{"key":"R2-20260416","first-page":"632","article-title":"Outcomes of the Fontan operation: A comprehensive review","volume":"138","author":"Cohen","year":"2018","journal-title":"Circulation"},{"key":"R3-20260416","first-page":"1536","article-title":"Late consequences of the Fontan operation","volume":"125","author":"Rychik","year":"2012","journal-title":"Circulation"},{"key":"R4-20260416","first-page":"1057","article-title":"Atrioventricular valve regurgitation in single-ventricle physiology","volume":"119","author":"Gelatt","year":"2017","journal-title":"Am J Cardiol"},{"key":"R5-20260416","first-page":"548","article-title":"Feeding difficulties in children with congenital heart disease","volume":"69","author":"DiMaria","year":"2019","journal-title":"J Pediatr Gastroenterol Nutr"},{"key":"R6-20260416","first-page":"e2021051579","article-title":"Pharmacologic management of heart failure in children","volume":"148","author":"Rossano","year":"2021","journal-title":"Pediatrics"},{"key":"R7-20260416","first-page":"1046","article-title":"Surgical repair of atrioventricular valve regurgitation in Fontan patients","volume":"160","author":"Egbe","year":"2020","journal-title":"J Thorac Cardiovasc Surg"}],"container-title":["Heart Views"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/heartviews.heartviews_133_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T18:57:42Z","timestamp":1786647462000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/heartviews.heartviews_133_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10]]},"references-count":7,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.4103\/heartviews.heartviews_133_25","relation":{},"ISSN":["1995-705X","0976-5123"],"issn-type":[{"value":"1995-705X","type":"print"},{"value":"0976-5123","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10]]},"assertion":[{"value":"2025-10-05","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-11-13","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}