Key result
Fontan physiology linked to nearly double the prevalence of chronic venous insufficiency versus controls.
Why the study?
The presence of abnormal peripheral hemodynamic conditions such as chronic venous insufficiency in adults with Fontan physiology and their potential contribution to adverse outcomes were not well known.
Cross-Sectional (n=159)
Yes
Answers are grounded in this paper and cite their sources.
Adults with Fontan physiology have a significantly higher prevalence of overall (60%) and severe (22%) lower extremity chronic venous insufficiency compared to healthy matched controls, driven by factors such as prior groin venous catheterizations and deep venous thrombosis.
Objectives The objective of this study was to document the prevalence of chronic venous insufficiency (CVI) and its associated factors in adults with Fontan physiology. Background As the 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. Methods A total 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. Results The prevalence 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 > or = 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. Conclusions CVI is 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.
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Valente et al. (2010) conducted a cross-sectional in Adults with congenital heart disease and Fontan physiology (n=159). Fontan physiology vs. Age-matched and sex-matched healthy controls was evaluated on Prevalence of lower extremity chronic venous insufficiency (CVI) (p=0.008). Adults with Fontan physiology had a higher prevalence of chronic venous insufficiency compared with healthy controls, including severe CVI.
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