Protein-losing enteropathy after fontan surgery: insights from Vietnamese clinical experience and the need for global collaboration

• Published in: Cardiology in the young Vol. 35; no. 5; p. 1057
• Main Authors: Tran, Dai Dac, Do, Tien Anh, Bui, Huy Quang, Le, Thanh Ngoc, Vo, Long Hoang
• Format: Journal Article
• Language: English
• Published: England 01.05.2025
• Subjects: Fontan Procedure - adverse effects; Heart Defects, Congenital - surgery; Humans; Postoperative Complications - epidemiology; Prevalence; Protein-Losing Enteropathies - diagnosis; Protein-Losing Enteropathies - epidemiology; Protein-Losing Enteropathies - etiology; Protein-Losing Enteropathies - therapy; Vietnam - epidemiology; Vietnam; postoperative complications; global collaboration; Protein-losing enteropathy; CHD; fontan procedure
• ISSN: 1467-1107
• DOI: 10.1017/S1047951125001581

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.