Arterial stiffness in adult patients after Fontan procedure.
OBJECTIVE
Increased 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.


RESULTS
Twenty 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).


CONCLUSIONS
Adult 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.
Institute of Cardiology, Jagiellonian University Medical College and John Paul II Hospital, 80 Pradnicka St,, 31-202 Krakow, Poland. ltom@wp.pl.
Lidia
L
Tomkiewicz-Pajak
Hanna
H
Dziedzic-Oleksy
Jacek
J
Pajak
Maria
M
Olszowska
Jacek
J
Kolcz
Monika
M
Komar
Piotr
P
Podolec
D000293:Adolescent; D000328:Adult; D001011:Aorta / Q000502:physiology; D050197:Atherosclerosis / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000503:physiopathology; D042241:Early Diagnosis; D004452:Echocardiography / Q000379:methods*; D005260:Female; D018729:Fontan Procedure / Q000009:adverse effects*; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D010100:Oxygen / Q000097:blood; D011673:Pulsatile Flow / Q000502:physiology; D013318:Stroke Volume / Q000502:physiology; D059289:Vascular Stiffness / Q000502:physiology*; D055815:Young Adult
D010100:Oxygen