David Rosenthal

@Katrina88215142 @mgoschu @ACTION4HF Certainly a challenging population for multiple reasons. Approximately 1/2 of Fontan patients listed for tx have low EF and can probably be supported with existing VAD technology albeit with steep learning curve...

@mgoschu @ACTION4HF @RosenthalDN Looking to the future of Fontan therapy, there has been a development in Fontan VAD implantation and management strategies. What are your thought on the future prospects of VADs in Fontan patients? #ACTIONJC

First question - @mgoschu @RosenthalDN in your opinion, what has the biggest change in Fontan management that you have seen over the past 10 years? (When commenting, please use the REPLY button to keep our threads in order. Don’t forget to include #ACTIONJC)

@AriCedars @ACTION4HF @mgoschu Do you think this is common amongst ACHD providers? #actionjc

@ACTION4HF @mgoschu @RosenthalDN I have this discussion w all my #fontan patients bc I know where they are going...#actionjc

@LortsAngie @ACTION4HF @mgoschu Seems like a good situation for collaborative QI with families and providers, right along lines that ACTION does well. #actionjc

@RosenthalDN @ACTION4HF @mgoschu I definitely think this is where @ACTION4HF can make things better. #ACTIONJC

@mgoschu @AuerbachScott @ACTION4HF Occlusion of the entire lymphatic system is pretty drastic. Surprising that it can even work although it sometimes seems to.

@AuerbachScott @ACTION4HF @RosenthalDN Unfortunately we have also see this. #ACTIONJC

@AuerbachScott @ACTION4HF @mgoschu Really important point. Occlusion of the entire lymphatic system is a pretty drastic treatment and likely to have unintended consequences.

@ACTION4HF @mgoschu @RosenthalDN I think we need more experience and understanding of the changes in lymphatics over the entire Fontan population. Interventions have potential to be beneficial but can add risk without reward, or cause new problems. 1/

@ACTION4HF @mgoschu Lymphatic occlusion seems most effective for plastic bronchitis, where it can probably be “curative”. For PLE, occlusion seems more palliative, but can still be great as bridge to tx, or for symptom relief.

@RosenthalDN @mgoschu Which types of patients can benefit most from some of these lymphatic interventions?

@ACTION4HF @mgoschu What do others in this thread think about these treatments? #actionjc

@ACTION4HF @mgoschu I am most impressed by the potential (and to a degree the reality) of lymphatic-oriented therapies, including occlusion and reimplantation. Not needed for everyone, but game changing in some cases. #actionjc

@ACTION4HF I’m here - just getting my feet on the ground with this format. #actionjc

Who's out there?! Please REPLY to this tweet with a brief introduction. Don’t forget to include #ACTIONJC in your replies, comments, and questions today. Added bonus for participation, let’s all FOLLOW each other so that we can grow our community! #ACTIONJC

@ACTION4HF @CircAHA Ready to jump in? First ACTION journal club. #actionjc

@CircAHA Please respond to any questions with the REPLY button. Post NEW questions/topics/comments by just tweeting. Don’t forget to include #ACTIONJC in your tweets.

Get ready for a flurry🌪🌪 of tweets & ACTION from @ACTION4HF. Our journal club/discussion of the @CircAHA Fontan statement starts at 3pm ET. Let’s see #ACTIONJC trending 📈