Abstract 11430: Clinical Significance of Impaired Vascular Endothelial Function in Patients After Fontan Procedure
Background: It has been reported that patients have reduced vascular endothelial function after Fontan procedure; however, its underlying mechanisms and correlation with exercise capacity are not widely known.
Purpose: We evaluated vascular endothelial function (flow-mediated dilatation [FMD]) in patients after Fontan procedure using conventional vascular ultrasonography and investigated the correlation between FMD and clinical profile.
Patients and Methods: Thirty-one patients who underwent the Fontan procedure (age, 12-55 years; median age, 20 years; postoperative duration, 9.5-31.8 years; median postoperative duration, 16.9 years) and 17 age- and sex-matched healthy subjects were enrolled in this study. We measured FMD in these patients. We examined the correlations between FMD and age, duration after the Fontan procedure, laboratory results (total cholesterol, triglyceride, hemoglobin A1c, fibrinogen and brain natriuretic peptide levels), hemodynamic profiles (central venous pressure, end-diastolic pressure, cardiac index, pulmonary vascular resistance, arterial oxygen saturation, systolic blood pressure), arterial stiffness index (pulse wave velocity [PWV], ankle brachial pressure index [ABI], stiffness parameter [β], elastic modulus [Ep]), and exercise tolerance (6-min walk distance).
Results: Patients who underwent the Fontan procedure had a lower FMD than healthy subjects (7.8 ± 1.9% vs. 11.0 ± 1.7%; p < 0.001). FMD showed a negative correlation with age, duration after the Fontan procedure (r, -0.68, p < 0.001 and r, -0.44, p = 0.014 respectively) and total cholesterol (r, -0.44, p = 0.020), but no significant correlation with hemodynamic characteristics. Considering arterial stiffness index, FMD showed a negative correlation with β and Ep (r, -0.65, p < 0.001 and r, -0.65, p < 0.001, respectively), but no significant correlation with PWV or ABI. FMD showed a positive correlation with 6-min walk distance (r, 0.38, p = 0.039).
Conclusions: Vascular endothelial dysfunction after the Fontan procedure contributes to reduced exercise tolerance and is likely related to collapse of the Fontan circulation. Vascular endothelial dysfunction is due to both a combination of Fontan hemodynamics and metabolic disorders.
Author Disclosures: S. Asagai: None. K. Inai: None. H. Tomimatsu: None. T. Shinohara: None. T. Nakanishi: None.
- © 2014 by American Heart Association, Inc.