Key result
Superficial tissue oxygen saturation was significantly reduced in adults with Fontan palliation compared to healthy controls (p=0.002) and tetralogy of Fallot patients (p=0.016).
Why the study?
Fontan physiology leads to long-term multi-organ dysfunction, creating a need for a non-invasive screening tool to identify impending decline.
Does vascular optical spectrophotometry detect differences in microvascular perfusion in adults with Fontan palliation compared to other patient groups and healthy controls?
Observational (n=47)
Does vascular optical spectrophotometry detect differences in microvascular perfusion in adults with Fontan palliation compared to other patient groups and healthy controls?
Vascular optical spectrophotometry is a feasible non-invasive tool that detects reduced superficial tissue oxygen saturation in patients with Fontan circulation, suggesting utility for monitoring microcirculatory function.
May support non-invasive microcirculatory monitoring in Fontan patients; hypothesis-generating and requires prospective validation.
Objective : The Fontan operation greatly improves survival for single ventricle congenital heart disease patients but creates a physiology that leads to long-term multi-organ dysfunction. A non-invasive screening tool that can identify impending decline is sought. The objective of this pilot study was to assess the microcirculation in Fontan-palliated patients by measuring tissue oxygen saturation (StO 2 ) in superficial and deeper tissues. Approach : Three patient cohorts were studied: Fontan group ( n = 8) and two patient control groups, liver disease group ( n = 8) and tetralogy of Fallot group ( n = 9). 22 healthy controls were also examined. Superficial and deeper StO 2 was measured at the forearm, thenar eminence, index and ring fingers of both arms using the LEA O2C spectrophotometry device. Main results : Superficial StO 2 was reduced in Fontan patients compared to healthy controls ( p = 0.002) and tetralogy patients ( p = 0.016), but not compared to the liver group ( p = 0.313). Deeper StO 2 was similar between groups ( p = 0.112). The gap between deeper and superficial StO 2 was raised in Fontan patients compared to healthy controls ( p = 0.001) and tetralogy patients ( p = 0.037), but not compared to the liver group ( p = 0.504). There was no clinically relevant difference in StO 2 between the left and right arms, and the variation in StO 2 according to measurement site was similar between the four groups. Significance : Vascular optical spectrophotometry is a feasible non-invasive measure of micro-circulatory function that can easily be performed in the clinic setting and may have utility in patients with Fontan circulations. Further, we provide important normal range data in the healthy control population which can be used to design future studies.
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Agarwal et al. (2019) conducted an observational in Fontan palliation (n=47). Fontan palliation vs. Healthy controls, liver disease, and tetralogy of Fallot patients was evaluated on Superficial tissue oxygen saturation (StO2) (p=0.002). Superficial tissue oxygen saturation was significantly reduced in adults with Fontan palliation compared to healthy controls (p=0.002) and tetralogy of Fallot patients (p=0.016).
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