title: Significance of right atrial tension for the development of complications in patients after atriopulmonary connection Fontan procedure: potential indicator for Fontan conversion.
abstract: Elevated right atrial (RA) pressure and progressive RA dilation are thought to play pivotal roles in the development of late complications after atriopulmonary connection (APC) Fontan surgery. However, no clear cut-off value for RA pressure or RA volume has been determined for stratifying the risk of developing Fontan complications. We hypothesized that RA tension, which incorporates information about both RA pressure and volume, might help predict the risk of developing complications. We retrospectively studied 51 consecutive APC Fontan patients (median postoperative period 14 years). RA tension was computed from the RA pressure and RA radius, which was calculated from RA volume measured by RA angiography. The correlation between the cardiac catheterization hemodynamic data and the complications of APC Fontan was investigated. Of the 51 patients, 28 had complications, including liver fibrosis (n = 28), arrhythmia (n = 8), protein-losing enteropathy (n = 1), and RA thrombosis (n = 1). Among the hemodynamic data, RA volume and RA tension, but not RA pressure, were significantly higher in patients with complications than in those without (P = 0.004 and P = 0.001, respectively). The cut-off level for RA tension to predict Fontan complications was 26,131 dyne/cm by receiver operating characteristic curve (area under the curve 0.79, sensitivity 71.4%, and specificity 73.9%). The present study demonstrated the significance of RA tension rather than high venous pressure for the development of Fontan complications. Amid the uncertainty about clinical outcomes, the present results, subject to further validation, may contribute to the indications for Fontan conversion.
authors.affiliation: Department of Pediatrics, Hokkaido University Graduate School, North-15 West-7, Sapporo, 060-8638, Japan. gaku-izumi0920@med.hokudai.ac.jp.|Department of Pediatric Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjyuku-ku, Tokyo, 162-8666, Japan. gaku-izumi0920@med.hokudai.ac.jp.
authors.forename: Gaku
authors.initials: G
authors.lastname: Izumi
authors.affiliation: Department of Pediatric Cardiology, Saitama Medical Centre, Saitama Medical University, 1981 Kamoda, Kawagoe, 350-8550, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Senzaki
authors.affiliation: Department of Pediatrics, Hokkaido University Graduate School, North-15 West-7, Sapporo, 060-8638, Japan.
authors.forename: Atsuhito
authors.initials: A
authors.lastname: Takeda
authors.affiliation: Department of Pediatrics, Hokkaido University Graduate School, North-15 West-7, Sapporo, 060-8638, Japan.
authors.forename: Hirokuni
authors.initials: H
authors.lastname: Yamazawa
authors.affiliation: Department of Pediatrics, Hokkaido University Graduate School, North-15 West-7, Sapporo, 060-8638, Japan.
authors.forename: Kohta
authors.initials: K
authors.lastname: Takei
authors.affiliation: Department of Pediatrics, Hokkaido University Graduate School, North-15 West-7, Sapporo, 060-8638, Japan.
authors.forename: Takuo
authors.initials: T
authors.lastname: Furukawa
authors.affiliation: Department of Pediatric Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjyuku-ku, Tokyo, 162-8666, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Inai
authors.affiliation: Department of Pediatric Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjyuku-ku, Tokyo, 162-8666, Japan.
authors.forename: Tokuko
authors.initials: T
authors.lastname: Shinohara
authors.affiliation: Division of Clinical Research for Adult Congenital Heart Disease Life-long Care and Pathophysiology, Department of Pediatric Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjyuku-ku, Tokyo, 162-8666, Japan.
authors.forename: Toshio
authors.initials: T
authors.lastname: Nakanishi
mesh_terms: D000293:Adolescent; D000328:Adult; D001145:Arrhythmias, Cardiac / Q000209:etiology; D002648:Child; D005260:Female; D018729:Fontan Procedure / Q000009:adverse effects* / Q000379:methods*; D006325:Heart Atria / Q000503:physiopathology*; D006330:Heart Defects, Congenital / Q000150:complications / Q000601:surgery; D006801:Humans; D007564:Japan; D008297:Male; D011183:Postoperative Complications / Q000209:etiology*; D011651:Pulmonary Artery / Q000503:physiopathology*; D012372:ROC Curve; D012189:Retrospective Studies; D013927:Thrombosis / Q000209:etiology; D055815:Young Adult
keywords: Atriopulmonary connection Fontan; Fontan complications; Right atrial tension