title: Anthropometric measures after Fontan procedure: implications for suboptimal functional outcome.
abstract: BACKGROUND
  Abnormal height and adiposity are observed after the Fontan operation. These abnormalities may be associated with worse functional outcome.
  
  
  METHODS
  We analyzed data from the National Heart, Lung, and Blood Institute Pediatric Heart Network cross-sectional study of Fontan patients. Groups were defined by height (z-score<-1.5 or≥-1.5) and body mass index (body mass index [BMI] z-score<-1.5 or -1.5 to 1.5 or≥1.5). Associations of anthropometric measures with measurements from clinical testing (exercise, echocardiography, magnetic resonance imaging) were determined adjusting for demographics, anatomy, and pre-Fontan status. Relationships between anthropometric measures and functional health status (FHS) were assessed using the Child Health Questionnaire.
  
  
  RESULTS
  Mean age of the cohort (n=544) was 11.9±3.4 years. Lower height-z patients (n=124, 23%) were more likely to have pre-Fontan atrioventricular valve regurgitation (P=.029), as well as orthopedic and developmental problems (both P<.001). Lower height-z patients also had lower physical and psychosocial FHS summary scores (both P<.01). Higher BMI-z patients (n=45, 8%) and lower BMI-z patients (n=53, 10%) did not have worse FHS compared to midrange BMI-z patients (n=446, 82%). However, higher BMI-z patients had higher ventricular mass-to-volume ratio (P=.03) and lower % predicted maximum work (P=.004) compared to midrange and lower BMI-z patients.
  
  
  CONCLUSIONS
  Abnormal anthropometry is common in Fontan patients. Shorter stature is associated with poorer FHS and non-cardiac problems. Increased adiposity is associated with more ventricular hypertrophy and poorer exercise performance, which may have significant long-term implications in this at-risk population.
authors.affiliation: The Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Meryl S
authors.initials: MS
authors.lastname: Cohen
authors.forename: Victor
authors.initials: V
authors.lastname: Zak
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Atz
authors.forename: Beth F
authors.initials: BF
authors.lastname: Printz
authors.forename: Nelangi
authors.initials: N
authors.lastname: Pinto
authors.forename: Linda
authors.initials: L
authors.lastname: Lambert
authors.forename: Victoria
authors.initials: V
authors.lastname: Pemberton
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Li
authors.forename: Renee
authors.initials: R
authors.lastname: Margossian
authors.forename: Carolyn
authors.initials: C
authors.lastname: Dunbar-Masterson
authors.forename: Brian W
authors.initials: BW
authors.lastname: McCrindle
mesh_terms: D001827:Body Height; D001835:Body Weight; D002648:Child; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005260:Female; D018729:Fontan Procedure / Q000379:methods*; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D050177:Overweight / Q000150:complications* / Q000503:physiopathology; D011184:Postoperative Period; D012307:Risk Factors; D011795:Surveys and Questionnaires