Thorac Cardiovasc Surg 2016; 64 - ePP72
DOI: 10.1055/s-0036-1571938

Hemodynamic Characteristics in Fontan Patients before the Onset of Protein-Losing Enteropathy or Plastic Bronchitis

F. du Bois 1, B. Stiller 1, T. Borth-Bruhns 2, B. Unseld 1, J. Grohmann 1, R. Höhn 1, T. Fleck 1
  • 1Universitäts-Herzzentrum Freiburg, Klinik für angeborene Herzfehler / Pädiatrische Kardiologie, Freiburg, Germany
  • 2Nachsorgeklinik Tannheim, Tannheim, Germany

Objectives: Few risk factors for the development of protein-losing enteropathy (PLE) and plastic bronchitis (PB) after Fontan operation have been identified, and there is a paucity of evidence for their pathogenetic mechanisms. In this retrospective study we analyzed baseline and specific hemodynamic characteristics of abdominal arteries in patients yet to develop PLE or PB to identify prognostic parameters for these complications.

Methods: A total of 105 Fontan patients who underwent Doppler-ultrasound examination of the main thoracic and abdominal arteries in a rehabilitation center between June 2006 and May 2013 were enrolled in a retrospective cohort study with a median follow-up of 5.8 (1.5–8.5) years. The study cohort comprised a case group (n = 14, 10 PLE and 4 PB cases) and a control group (n = 91).

Results: Case group 1 (n = 8; 5 PLE and 3 PB cases) included patients with PLE or PB already prevalent during examination. The remaining n = 6 patients (5 PLE and 1 PB case) in case group 2 developed one of these complications after examination within a median time of 13.5 (4–44) months. PLE or BP development was associated with hypoplastic left-heart syndrome (OR = 3.33, 95% KI 1.05–10.59; p = 0,041). We measured significantly higher median resistance indices in the celiac trunk (CT) in patients who later developed PLE (p = 0,011). Furthermore, lower diastolic flow velocities in the superior mesenteric artery (SMA) and CT (p = 0,021 and p = 0,036) in patients with PLE or PB were observed prior to the onset of the diseases.

Conclusion: Patients yet to develop PLE revealed higher resistance indices in CT and slower diastolic flow velocities in CT and SMA. These findings indicate elevated flow resistance in intestinal arteries and suggest that these conditions may be predictive for the development of PLE and/or PB. Studies including larger numbers of affected patients are needed to investigate this pathogenetic approach further.