Abstract 12791: Acute Volume Loading During Invasive Testing Identifies Fontan Survivors With Occult Diastolic Dysfunction
Introduction: Invasive hemodynamic assessment of the Fontan patient is often unrevealing, even in the presence of clinical symptoms. Diastolic dysfunction (DD), a key driver of long-term clinical outcomes, may frequently be concealed during standard hemodynamic evaluation.
Hypothesis: Volume loading during invasive assessment may identify Fontan patients with occult DD.
Methods: Single center record review of cardiac catheterizations with volume loading in Fontan patients from 2012 - 2014. Patients with baseline DD, defined as a ventricular end diastolic pressure of ≥ 15 mmHg, were excluded. Following acquisition of baseline data, a 15 ml/kg normal saline intravenous bolus was administered rapidly. After a 5 min equilibration phase, hemodynamics were reassessed. Comparisons were made using paired Student’s t-test. Risk factors for occult DD were assessed using Wilcoxon rank-sum test.
Results: Twenty-three Fontan patients (48% female, 74% left ventricular morphology) were included. Median age was 17.7 (IQR 7.5, 21.4) years and mean duration of Fontan circulation was 12.9 ± 9.1 years. Hemodynamic data are shown in Table 1. Volume loading revealed occult DD in 8 (35%) patients (Fig 1). Age (21.3 vs. 11.8 years, p=0.05) and duration of Fontan circulation (21.1 vs. 10.6 years, p=0.04) were associated with occult DD, whereas ventricular morphology was not. There were no adverse events related to volume loading.
Conclusions: Occult DD is common in Fontan patients, and may be identified with volume loading during invasive hemodynamic assessment. Older age and longer duration of Fontan circulation were associated with a greater likelihood of occult DD.
Author Disclosures: K. Averin: None. R. Hirsch: None. M. Seckeler: None. R.H. Beekman: None. B.H. Goldstein: None.
- © 2014 by American Heart Association, Inc.