Venous congestion and pulmonary vascular function in Fontan circulation: Implications for prognosis and treatment

International Journal of Cardiology
Alexander EgbeBarry A Borlaug

Abstract

Elevation in central venous pressure (CVP) plays a fundamental pathophysiologic role in Fontan circulation. Because there is no sub-pulmonary ventricle in this system, CVP also provides the driving force for pulmonary blood flow. We hypothesized that this would make Fontan patients more susceptible to even low-level elevation in pulmonary vascular resistance index (PVRI), resulting in greater systemic venous congestion and adverse outcomes. Adult Fontan patients and controls without congenital heart disease undergoing clinical evaluation that included cardiac catheterization and echocardiography were examined retrospectively. Outcomes including all-cause mortality and the development of Fontan associated diseases (FAD, defined as protein losing enteropathy, cirrhosis, heart failure hospitalization, arrhythmia, or thromboembolism) were assessed from longitudinal assessment. As compared to controls (n = 82), Fontan patients (n = 164) were younger (36 vs 45 years, p < 0.001), more likely to be on anticoagulation or antiplatelet therapy, and more likely to have atrial arrhythmia or cirrhosis. There was a strong correlation between CVP and PVRI in the Fontan group (r = 0.79, p < 0.001), but there was no such relationship in controls...Continue Reading

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Citations

Nov 19, 2019·Acta Paediatrica·Marc GewilligJack Rychik
Mar 19, 2020·Heart Failure Reviews·Christopher R BrodaAnitha S John
May 15, 2021·Korean Journal of Radiology : Official Journal of the Korean Radiological Society·Hyun Woo GooDong Man Seo
Jul 1, 2021·ESC Heart Failure·Tarek AlsaiedGruschen R Veldtman
Dec 5, 2020·Journal of the American College of Cardiology·Alexander C EgbeBarry A Borlaug

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