Arterial stiffness in adult patients after Fontan procedure

Abstract

ObjectivesIncreased arterial stiffness is a risk factor of atherosclerosis and cardio-vascular complications. The aim of the study was to determine whether peripheral vascular function might be an early marker of impaired health status in patients with a single ventricle after Fontan procedure.Methods and resultsTwenty five consecutive adults (11 women and 14 men) aged 24.7 ± 6.2 years after the Fontan procedure and 25 sex, age and BMI match healthy volunteers underwent physical examination, blood analysis, transthoracic echocardiography and noninvasive assessment of aortic stiffness. Augmented pressure and Augmentation Index (AIx) were both significantly elevated in Fontan when compared to the controls (6,08 ± 0,7 vs. 2,0 ± 3,7; p = 0.002 and 17,01 ± 3,3 vs. 6,05 ± 11; p < 0.001, respectively). There were no differences in pulse wave velocity (PWV), mean blood pressure (BP), brachial pulse pressure (PP), central: systolic BP, diastolic BP and PP. In Fontan group we find negative correlation between PWV and SatO2 (r = −0.68; p = 0.04) and positive correlation with WBC (0.72; p = 0.72; p = 0.013), INR (0.81; p = 0.008), TNFα (r = 0.45; p = 0.04), and postoperative time (r = 0.77; p = 0.02). AIx correlates positively only with age at surgery (r = 0.45; p = 0.04). Bilirubin level correlates positively with brachial PP (r = 0.71; p = 0.02) and central PP (r = 0.68; p = 0.03).The multivariate model showed that SatO2 (β = −0.44, p = 0.04) was the only independent predictor of PWV (R2 = 0.32, p = 0.03).ConclusionAdult Fontan patients have an increased arterial stiffness assessed by a noninvasive technique. Low arterial oxygen saturation postoperative time, age at surgery, white blood cells, TNFα and bilirubin level are associated with arterial stiffening in these patients. The combination of blood parameters of the hepatic function and noninvasive measurements of arterial stiffness could be helpful in comprehensive care of patients with Fontan circulation.

Cardiovascular adaptation to the Fontan circulation

“…Also coupling of an adversely remodeled single ventricle to an abnormal systemic arterial load is likely to profoundly challenge the ventricle's contractile reserve. Data from divergent investigative approaches suggest that vascular characteristics in Fontan patients are pathologically altered . Computer modeling incorporating the influences of intrathoracic pressure on venous return and the effects of baroreceptor reflexes, suggests that Fontan hemodynamics are best simulated by a state in which baroreceptor activity is increased.…”

“…Data from divergent investigative approaches suggest that vascular characteristics in Fontan patients are pathologically altered. [47][48][49] Computer modeling incorporating the influences of intrathoracic pressure on venous return and the effects of baroreceptor reflexes, suggests that Fontan hemodynamics are best simulated by a state in which baroreceptor activity is increased. Such activation increases splanchnic and extra-splanchnic arteriolar resistance, filling pressures, and ventricular contractility.…”

Arterial stiffness and arterial function in adult cyanotic patients with congenital heart disease

“…Based on that ground lately also for patients with CHD, studies on vascular changes started to appear in the literature. Unfortunately available papers concerning cyanotic CHD present data from small groups of patients [5,[11][12][13][14][21][22][23][24][25][26], often from children [27][28][29][30].…”

Determinants of Aortic Size and Stiffness and the Impact on Exercise Physiology in Patients After the Fontan Operation

“…Anatomical and functional properties of dilated aAO have been studied in patients with tetralogy of Fallot; [25][26][27] however, little data on these aortic properties and their clinical significance are available in Fontan patients. 28,29) Accordingly, we evaluated aortae in Fontan patients to clarify the aortic size and stiffness and hypothesized the following: 1) aortic size and stiffness of Fontan patients are different from those of control patients; 2) these abnormalities are associated with Fontan hemodynamics and traditional biomarkers for cardiovascular disease; and 3) aortic stiffness has a significant impact on exercise physiology.…”