Abstract 2138: Congenital Heart Disease in Adults Lower Extremity Systemic Venous Health in Fontan Patients Study
Background- As the population of adults with complex congenital heart disease and Fontan physiology increases, so does occurrence of highly morbid and mortal outcomes including heart failure and thromboembolism. The presence of abnormal peripheral hemodynamics in this population and their potential contribution to adverse outcomes is not well known. The objective of this study is to document the prevalence of chronic venous insufficiency (CVI) in adults with Fontan physiology.
Methods and Results- One hundred fifty-nine adults with Fontan physiology from 7 adult congenital heart centers and 65 age and sex-matched controls were prospectively assessed. Lower extremity CVI was systematically assigned a clinical, etiologic, anatomical, and pathophysiological (CEAP) classification grade. Leg photographs were independently re-assessed to confirm interobserver reliability. Prevalence of CVI was significantly greater in the Fontan population compared to healthy controls (60% vs. 32%, p = 0.008). The prevalence of severe CVI (Figure⇓) was significantly higher in the Fontan group compared to healthy controls (22% vs. 0%, p = 0.005). In multivariate analyses, factors independently associated with severe CVI included male gender, older age, increased numbers of catheterizations with groin venous access, itching and deep venous thrombosis.
Conclusion - CVI is highly prevalent in adults with congenital heart disease and Fontan physiology and is often severe. The contribution of abnormal peripheral hemodynamic conditions to comorbidities including thromboembolism and heart failure, and interventions to the impact of directed therapies need to be further explored.