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(Circulation. 2006;113:1123-1129.)
© 2006 American Heart Association, Inc.

Pediatric Cardiology

Relationship of Patient and Medical Characteristics to Health Status in Children and Adolescents After the Fontan Procedure

Brian W. McCrindle, MD, MPH; Richard V. Williams, MD; Paul D. Mitchell, MSc; Daphne T. Hsu, MD; Stephen M. Paridon, MD; Andrew M. Atz, MD; Jennifer S. Li, MD; Jane W. Newburger, MD, MPH, for the Pediatric Heart Network Investigators

From the University of Toronto, Hospital for Sick Children, Toronto, Canada (B.W.M.); University of Utah, Salt Lake City (R.V.W.); New England Research Institutes, Watertown, Mass (P.D.M.); Columbia University Medical Center, New York, NY (D.T.H.); Children’s Hospital of Philadelphia, Philadelphia, Pa (S.M.P.); Medical University of South Carolina, Charleston (A.M.A.); Duke University Medical Center, Durham, NC (J.S.L.); and Children’s Hospital Boston, Boston, Mass (J.W.N.).

Reprint requests to Dr Brian McCrindle, Hospital for Sick Children, 555 University Ave, Toronto, Ontario, Canada M5G 1X8. E-mail brian.mccrindle{at}sickkids.ca

Received July 18, 2005; revision received December 2, 2005; accepted December 23, 2005.

Background— After the Fontan procedure, patients are at risk for suboptimal health status related to their complex healthcare experience, physiological limitations, medical complications, and guarded long-term prognosis.

Methods and Results— In the Pediatric Heart Network cross-sectional study of Fontan survivors 6 to 18 years of age, parents completed the Child Health Questionnaire, and scores were related in multivariable analysis to patient and medical characteristics obtained from medical record review. For 537 patients (mean age at study, 11.9 years; 60% male) with a median age at Fontan of 2.8 years (range, 0.7 to 14.6 years), parent-reported patient morbidities included deficits in vision in 33%, speech in 27%, and hearing in 7%, as well as problems with attention in 46%, learning in 43%, development in 24%, behavior in 23%, anxiety in 17%, and depression in 8%. Child Health Questionnaire summary scores were significantly lower than the US population sample for Physical Functioning (mean Z score, –0.47±1.19; P<0.001) and Psychosocial Functioning (–0.28±1.08; P<0.001). Parent-reported medical conditions and long-term and current medical problems explained the greatest amount of variation in the Physical Functioning scores. Parent-reported patient conditions, including behavior, learning, anxiety, and attention problems and depression, explained the greatest amount of variation in the Psychosocial Functioning scores. Lower family income had a negative impact on both Physical and Psychosocial Functioning.

Conclusions— There are deficits in health status in children and adolescents after the Fontan procedure. Strategies to address this problem might emphasize coordinated and effective prevention, detection, and management of noncardiac and psychosocial conditions, as well as specific targeting of patients from low-income households.

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