Author/Authors :
Valente، نويسنده , , Anne Marie and Bhatt، نويسنده , , Ami B. and Cook، نويسنده , , Stephen and Earing، نويسنده , , Michael G. and Gersony، نويسنده , , Deborah R. and Aboulhosn، نويسنده , , Jamil and Opotowsky، نويسنده , , Alexander R. and Lui، نويسنده , , George and Gurvitz، نويسنده , , Michelle M. Graham، نويسنده , , Dionne and Fernandes، نويسنده , , Susan M. and Khairy، نويسنده , , Paul and Webb، نويسنده , , Gary and Gerhard-Herman، نويسنده , , Marie and Landzberg، نويسنده , , Michael J.، نويسنده ,
Abstract :
Objectives
jective of this study was to document the prevalence of chronic venous insufficiency (CVI) and its associated factors in adults with Fontan physiology.
ound
population of adults with complex congenital heart disease and Fontan physiology increases, so does the occurrence of highly morbid and mortal outcomes, including heart failure and thromboembolism. The presence of abnormal peripheral hemodynamic conditions in this population and their potential contribution to adverse outcomes is not well known. The primary objective of this study was to document the prevalence of CVI in adults with Fontan physiology.
s
l of 159 adults with Fontan physiology from 7 adult congenital heart centers were prospectively assessed for lower extremity CVI, with the assignment of clinical, etiological, anatomical, and pathophysiological classification grades, and compared with age-matched and sex-matched controls. Leg photographs were independently reassessed to confirm interobserver reliability.
s
evalence of CVI was significantly greater in the Fontan population (60%; 95% confidence interval [CI]: 52% to 68%) compared with healthy controls (32%; 95% CI: 15% to 54%) (p = 0.008). Strikingly, the prevalence of severe CVI (clinical, etiological, anatomical, and pathophysiological grade ≥4) was significantly higher in the Fontan group (22%; 95% CI: 16% to 29%) versus the healthy controls (0%; 95% CI: 0% to 14%) (p = 0.005). In a multivariate analysis, several factors were independently associated with severe CVI, including increased numbers of catheterizations with groin venous access, lower extremity itching, and deep venous thrombosis.
sions
common in adult patients with congenital heart disease with Fontan physiology. The contribution of abnormal peripheral hemodynamic conditions to comorbidities, including thromboembolism and heart failure, and interventions to improve peripheral hemodynamic conditions require further exploration.
