Abstract 10504: Patient, Medical and Laboratory Characteristics Associated With a Decline in Physical Functioning in Children and Adolescents After the Fontan Procedure
Background: Despite hypothesized concerns about deterioration beginning in adolescence, longitudinal data and associated factors regarding standardized assessment of physical functioning are not available for Fontan patients.
Methods and Results: Parents of 245 children and adolescents who participated in the Pediatric Heart Network Fontan Cross-Sectional Study completed the Child Health Questionnaire at two time points. Associations between change in Physical Functioning Summary Score and baseline patient, medical and laboratory characteristics (mean age 9.5±1.7 years) and follow-up patient and medical characteristics (mean age 16.2±1.6 years) were determined by regression analyses. The Psychosocial Functioning Summary Score was higher but the Physical Functioning Summary Score was not different at baseline compared to 70 eligible subjects who declined or had incomplete data. Over a mean follow-up interval of 6.7±0.4 years, a statistically significant but small and clinically unimportant decline was noted in Physical Functioning Summary Score, from 46.2±11.7 to 44.5±12.1 (p<0.03). Subjects with higher baseline scores had a greater decline in score (r=-0.48; p<0.001). A multivariable model of patient and medical characteristics (adjusted R2=0.11) showed that a greater decline in score was significantly associated with development of asthma (n=13; -6.6 points; p<0.05) or other chronic respiratory, lung or breathing problems (n=13; -12.5 points; p<0.001) during follow-up, and the presence of protein-losing enteropathy at any time (n=5 at baseline and n=8 during follow-up; -9.4 points; p=0.006). Change in score was not significantly associated with baseline exercise testing variables, BNP levels or ventricular characteristics and function measured by echocardiography or MRI.
Conclusions: Although physical functioning may be stable during adolescence for many Fontan patients, deterioration occurs in some in association with respiratory conditions and protein-losing enteropathy. Further longitudinal study is necessary to better understand the relationship between clinical morbidities and functional health status as these patients transition into adulthood.
- © 2013 by American Heart Association, Inc.