Abstract 14624: Unique Hormonal Response After Fontan Operation: Aldosterone-Cortisol Imbalance
Background: Immediately after the Fontan operation, patients exhibit abnormal water metabolism that leads to the development of edema and pleural effusion. Increased central venous pressure (CVP) and reduced cardiac output (CO) after the procedure can damage the end organs, including the kidneys and the adrenal gland, important organs that modulate water metabolism. We tested our hypothesis that Fontan circulation immediately after the operation has the unique features of abnormal responses of adrenal hormones (cortisol and aldosterone) that are associated with abnormal renal flow and function.
Methods and Results: The total daily urinary excretion of cortisol and aldosterone was measured every 24 hours postoperatively in 16 Fontan patients and 12 patients who underwent biventricular repair (non-Fontan patients). The relationship of hormonal excretion with hemodynamic status, and renal flow and function of the 2 groups was compared. Peak cortisol excretion was noted on operation day in non-Fontan patients, but was delayed until postoperative day 2 in Fontan patients (p = 0.02). In contrast, aldosterone levels increased immediately after surgery only in Fontan patients and remained high thereafter (p < 0.01, vs. non-Fontan patients). Thus, the cortisol/aldosterone ratio was significantly reduced in Fontan patients on the first 3 postoperative days (p < 0.05). Multivariate regression analysis revealed that total daily cortisol was significantly correlated with CO and urine output and that total daily aldosterone was significantly correlated with mean blood pressure, CVP, and reduced creatinine clearance (CCr). Renal blood flow was significantly correlated with CCr and urine output; it increased when cortisol increased and decreased when aldosterone increased (both, p < 0.05).
Conclusions: Increased aldosterone secretion with impaired cortisol secretion occurred specifically after the Fontan operation. This unique postoperative hormonal profile significantly reduced renal blood flow and function. Hormonal status modulation (i.e., cortisol substitution and antagonism of aldosterone) could be a useful therapeutic target to reduce postoperative complications after the Fontan operation.
- © 2013 by American Heart Association, Inc.