Objective: This study aims to assess the impact of complications of the Fontan operation, such as protein-losing enteropathy and thrombosis, on patients' quality of life. We hypothesize that alterations in the diameter and flow of the inferior vena cava (VCI) and femoral vein (FV) are associated with these complications. The goal is to evaluate the influence of venous structural modifications on Fontan operation outcomes by analyzing Doppler time measurements of the VCI, FV, aorta (Ao), and femoral artery (FA).
Materials and Methods: We retrospectively analyzed the recorded images of patients who had undergone Fontan palliation at least two years prior to presentation at our outpatient clinic between January 2022 and January 2023. Patients with chest pain but no cardiac pathology served as controls. Demographic and physical examination data were collected retrospectively. In patients with a normal single-ventricular ejection fraction, we measured the widest VCI diameter and Doppler values, the descending aortic diameter in systole, the widest FV diameter and Doppler values, and the femoral artery diameter in systole.
Results: The study included 25 Fontan patients: 7 had an extracardiac Fontan, 4 had a fenestrated extracardiac Fontan, and 14 had an intra-extracardiac fenestrated Fontan. A significant difference (p=0.019) was found in the age at Fontan between patients with NYHA stages 1-2 and those with NYHA stages 3-4. A pathologic microalbumin/creatinine ratio (>15) was correlated with pre-Fontan pulmonary artery pressure >15 mmHg. The VCI/BSA (p=0.031) and FV/BSA ratios differed significantly between groups with and without complications, with lower ratios observed in the group with complications.
Conclusion: Age at Fontan palliation is a risk factor for complications. High pre-Fontan pulmonary pressure is associated with microalbuminuria. VCI/BSA and FV/BSA are inversely associated with mid- to long-term complications following Fontan palliation.