title: Aldosterone-cortisol imbalance immediately after fontan operation with implications for abnormal fluid homeostasis.
abstract: Abnormal water metabolism is frequently observed after Fontan surgery. We hypothesized that patients' adrenal hormones show unique responses immediately after Fontan operation and that such a hormonal profile is related to postoperative hemodynamics and water imbalance. Twenty-eight patients who underwent a Fontan operation (n = 16) or a non-Fontan type operation (n = 12; controls) under cardiopulmonary bypass were studied. Postoperative urine cortisol and aldosterone levels were measured daily to minimize the influence of circadian rhythms and temporal hemodynamic variations. Cortisol excretion was markedly elevated on postoperative day (POD) 0 in controls, consistent with a stress-induced cortisol response. Cortisol excretion was not high on POD 0 in Fontan patients and was markedly lower than that in the controls (444 ± 150 vs 34 ± 6 μg/m(2)/day, p <0.05), indicating an adrenal insufficiency status. Conversely, aldosterone levels were significantly higher in Fontan patients than in controls immediately after surgery and remained so thereafter. The cortisol-to-aldosterone ratio was significantly lower in Fontan patients on POD 0 (p <0.05 vs controls); low cortisol-to-aldosterone ratios were associated with a longer pleural drainage duration and intensive care unit stay. Daily cortisol and aldosterone levels were significantly associated with postoperative hemodynamics; low cortisol levels correlated with low cardiac and urine outputs, whereas high aldosterone levels correlated with low cardiac output and increased blood pressure and central venous pressure. Thus, aldosterone-to-cortisol imbalance occurred specifically after the Fontan operation. This unique hormonal profile significantly affected patients' postoperative water balance and hemodynamics. Modulation of the adrenal hormone could be useful for reducing postoperative complications after the Fontan operation.
authors.affiliation: Division of Pediatric Cardiology, Saitama Medical Center, Saitama Medical University, Saitama, Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Saiki
authors.affiliation: Division of Pediatric Cardiology, Saitama Medical Center, Saitama Medical University, Saitama, Japan.
authors.forename: Seiko
authors.initials: S
authors.lastname: Kuwata
authors.affiliation: Division of Pediatric Cardiology, Saitama Medical Center, Saitama Medical University, Saitama, Japan.
authors.forename: Clara
authors.initials: C
authors.lastname: Kurishima
authors.affiliation: Division of Pediatric Cardiology, Saitama Medical Center, Saitama Medical University, Saitama, Japan.
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Iwamoto
authors.affiliation: Division of Pediatric Cardiology, Saitama Medical Center, Saitama Medical University, Saitama, Japan.
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Ishido
authors.affiliation: Division of Pediatric Cardiology, Saitama Medical Center, Saitama Medical University, Saitama, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Masutani
authors.affiliation: Division of Pediatric Cardiology, Saitama Medical Center, Saitama Medical University, Saitama, Japan. Electronic address: hsenzaki@saitama-med.ac.jp.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Senzaki
mesh_terms: D000450:Aldosterone / Q000097:blood*; D001794:Blood Pressure; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D018729:Fontan Procedure; D006330:Heart Defects, Congenital / Q000378:metabolism* / Q000503:physiopathology / Q000601:surgery; D006706:Homeostasis / Q000502:physiology*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D008297:Male; D011183:Postoperative Complications / Q000378:metabolism*; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D000450:Aldosterone; D006854:Hydrocortisone