Donate Help Contact The AHA Sign In Home
American Heart Association
Circulation
Search: search_blue_button Advanced Search
Circulation. 2006;113:1123-1129
Published online before print February 20, 2006, doi: 10.1161/CIRCULATIONAHA.105.576660
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Data Supplement
Right arrow All Versions of this Article:
113/8/1123    most recent
CIRCULATIONAHA.105.576660v1
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by McCrindle, B. W.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by McCrindle, B. W.
Related Collections
Right arrow Pediatric and congenital heart disease, including cardiovascular surgery

(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.


 

CLINICAL PERSPECTIVE




This article has been cited by other articles:


Home page
PediatricsHome page
L. M. Lambert, L. L. Minich, J. W. Newburger, M. Lu, V. L. Pemberton, E. A. McGrath, A. M. Atz, M. Xu, E. Radojewski, D. Servedio, et al.
Parent- Versus Child-Reported Functional Health Status After the Fontan Procedure
Pediatrics, November 1, 2009; 124(5): e942 - e949.
[Abstract] [Full Text] [PDF]


Home page
J. Thorac. Cardiovasc. Surg.Home page
K. C. Odegard, D. Zurakowski, J. A. DiNardo, R. A. Castro, F. X. McGowan Jr., E. J. Neufeld, and P. C. Laussen
Prospective longitudinal study of coagulation profiles in children with hypoplastic left heart syndrome from stage I through Fontan completion
J. Thorac. Cardiovasc. Surg., April 1, 2009; 137(4): 934 - 941.
[Abstract] [Full Text] [PDF]


Home page
Am. J. Physiol. Heart Circ. Physiol.Home page
K. S. Sundareswaran, K. Pekkan, L. P. Dasi, K. Whitehead, S. Sharma, K. R. Kanter, M. A. Fogel, and A. P. Yoganathan
The total cavopulmonary connection resistance: a significant impact on single ventricle hemodynamics at rest and exercise
Am J Physiol Heart Circ Physiol, December 1, 2008; 295(6): H2427 - H2435.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll CardiolHome page
P. A.W. Anderson, L. A. Sleeper, L. Mahony, S. D. Colan, A. M. Atz, R. E. Breitbart, W. M. Gersony, D. Gallagher, T. Geva, R. Margossian, et al.
Contemporary Outcomes After the Fontan Procedure: A Pediatric Heart Network Multicenter Study
J. Am. Coll. Cardiol., July 8, 2008; 52(2): 85 - 98.
[Abstract] [Full Text] [PDF]


Home page
J. Thorac. Cardiovasc. Surg.Home page
A. D. Blaufox, L. A. Sleeper, D. J. Bradley, R. E. Breitbart, A. Hordof, R. J. Kanter, E. A. Stephenson, M. Stylianou, V. L. Vetter, J. P. Saul, et al.
Functional status, heart rate, and rhythm abnormalities in 521 Fontan patients 6 to 18 years of age
J. Thorac. Cardiovasc. Surg., July 1, 2008; 136(1): 100 - 107.
[Abstract] [Full Text] [PDF]


Home page
PediatricsHome page
K. Uzark, K. Jones, J. Slusher, C. A. Limbers, T. M. Burwinkle, and J. W. Varni
Quality of Life in Children With Heart Disease as Perceived by Children and Parents
Pediatrics, May 1, 2008; 121(5): e1060 - e1067.
[Abstract] [Full Text] [PDF]


Home page
CirculationHome page
W. M. Gersony
Fontan Operation After 3 Decades: What We Have Learned
Circulation, January 1, 2008; 117(1): 13 - 15.
[Full Text] [PDF]


Home page
Arch. Dis. Child.Home page
B. W McCrindle, R. V Williams, S. Mital, B. J Clark, J. L Russell, G. Klein, and J. C Eisenmann
Physical activity levels in children and adolescents are reduced after the Fontan procedure, independent of exercise capacity, and are associated with lower perceived general health
Arch. Dis. Child., June 1, 2007; 92(6): 509 - 514.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll CardiolHome page
H. M. Krumholz and F. A. Masoudi
The Year in Epidemiology, Health Services Research, and Outcomes Research
J. Am. Coll. Cardiol., November 7, 2006; 48(9): 1886 - 1895.
[Full Text] [PDF]