Abstract 19933: Late Fontan Completion Associates with a Reduced Distensibility of the Ascending Aorta in Long-term Fontan Survivors
Background: Stiffened and dilated ascending aorta (AAo) before and long after operation, which may be an important predictor of cardiovascular morbidity and mortality has been reported in Fontan patients. However, the determinant of reduced distensibility has not been clarified.
Methods: Ninety nine postoperative F patients followed-up over 15 years were included (age at Fontan ; 4.5 +/- 5.2 years old). All patients underwent cardiac catheterization with aortography before and 15 years after operation (F0, F15). We measured the diameters of the AAo and descending aorta (DAo) from the cine-angiogram, and standardized by body height. We also calculated the stiffness parameters of the AAo and DAo (β(AAo),β(DAo)) with the corresponding systolic and diastolic pressures and distensible change of diameters. We compared the β(AAo) at F15 with clinical variables, including hemodynamics before and 15-year after the F operation.
Results: In the univariate analysis, β(AAo) at F15 was positively correlated with age at F operation (p < 0.001), β(DAo) at F15 (p = 0.025), β(AAo) at F0 (p = 0.026) , end-diastolic pressure of systemic ventricle (EDP) at F15 (p = 0.019), number of surgical interventions before F operation (p < 0.001), and was negatively correlated with ejection fractions at F0 (p = 0.047) and F15 (p = 0.047). In the multivariate analysis, age at F operation (p = 0.004), number of surgical interventions before F operation (p < 0.001), EDP at F15 (p = 0.036) were independently correlated with β(AAo) at F15.
Conclusions: Delayed Fontan completion leads to the stiffened ascending aorta and may result in increase in end-diastolic pressure of ventricle long after operation. Early Fontan completion may prevent progressions of stiffened aorta and ventricular dysfunction.
Author Disclosures: Y. Hayama: None. H. Ohuchi: None. A. Miyazaki: None. S. Yazaki: None. E. Tsuda: None. O. Yamada: None.
- © 2014 by American Heart Association, Inc.