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Hemodynamic Phenotype of the Failing Fontan in an Adult Population
- Source :
- The American Journal of Cardiology. 112:1943-1947
- Publication Year :
- 2013
- Publisher :
- Elsevier BV, 2013.
-
Abstract
- Fontan failure can occur even with normal systolic ventricular function and often in the context of significant liver disease. We hypothesized that Fontan failure is hemodynamically distinct from traditional heart failure and characterized by low systemic vascular resistance (SVR) index and preserved cardiac index. Twenty-seven symptomatic adult Fontan (SAF) patients who underwent catheterization from 2001 to 2011 constituted our study group. Fifty-four predominantly asymptomatic pediatric Fontan (PF) patients who underwent catheterization during the same period were randomly selected to perform a control:case cohort analysis. Clinical comparisons were made between the 2 groups. The adults were more symptomatic than the PF cohort (New York Heart Association classes I and II or III and IV: 48% or 52% [SAF] vs 94% or 6% [PF], respectively, p0.01). SAF versus PF mean catheterization findings were central venous pressure 18 ± 6 versus 14 ± 3 mm Hg (p0.01), SVR index 1,680 ± 368 versus 1,960 ± 550 dyn s/cm(5)/m(2) (p = 0.02), and cardiac index 2.7 ± 0.8 versus 2.8 ± 0.7 L/min/m(2) (p = 0.25). By imaging, the SAF cohort demonstrated a greater incidence of abnormal liver texture changes (96% vs 75%, p = 0.04) and nodularity (77% vs 42%, p = 0.02). In conclusion, adult patients with failing Fontan circulation had a lower SVR index and similar cardiac index compared with the pediatric cohort. Liver disease in the adults was more advanced. Our data suggest that Fontan failure is a distinct circulatory derangement with hemodynamic features similar to portal hypertension, albeit with limited ability to augment cardiac output.
- Subjects :
- Adult
Male
Cardiac output
medicine.medical_specialty
Protein-Losing Enteropathies
medicine.medical_treatment
Cardiac index
Fontan Procedure
Asymptomatic
Article
Fontan procedure
Young Adult
Postoperative Complications
Internal medicine
medicine
Humans
Cardiac Output
Retrospective Studies
Heart Failure
Exercise Tolerance
business.industry
Liver Diseases
Hemodynamics
Retrospective cohort study
Middle Aged
medicine.disease
medicine.anatomical_structure
Heart failure
Cohort
Cardiology
Vascular resistance
Female
medicine.symptom
Cardiology and Cardiovascular Medicine
business
Subjects
Details
- ISSN :
- 00029149
- Volume :
- 112
- Database :
- OpenAIRE
- Journal :
- The American Journal of Cardiology
- Accession number :
- edsair.doi.dedup.....69c6175f6743d4c7f13ecadd9ea8a063