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Altered endothelial function following the Fontan procedure.

Maria A Binotto1, Nair Y Maeda, Antonio A Lopes

  • 1Department of Paediatric Cardiology and Adult Congenital Heart Disease, Heart Institute (InCor), Universidade de São Paulo, Avenida Dr Eneas Carvalho de Aguiar 44, São Paulo, Brazil. angelica.binotto@incor.usp.br

Cardiology in the Young
|December 21, 2007
PubMed
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Patients with Fontan circulation show signs of endothelial dysfunction, indicated by elevated von Willebrand factor. However, their fibrinolysis appears preserved, suggesting a complex vascular response post-procedure.

Area of Science:

  • Cardiovascular Research
  • Pediatric Cardiology
  • Vascular Biology

Background:

  • Thrombosis is a known complication following the Fontan procedure.
  • The vascular endothelium is crucial for regulating coagulation and fibrinolysis.
  • Understanding endothelial function post-Fontan is vital for patient management.

Purpose of the Study:

  • To assess endothelial function and fibrinolysis in late postoperative Fontan patients.
  • To investigate potential impairments in vascular health after modified Fontan procedures.

Main Methods:

  • Compared 23 Fontan patients (7-26 years) with age-matched healthy controls.
  • Measured plasma levels of von Willebrand factor antigen, tissue-type plasminogen activator antigen, plasminogen activator inhibitor-1, and D-dimer.

Related Experiment Videos

  • Utilized venous occlusion testing and enzyme-linked immunosorbent assay.

    • Main Results:

    • Fontan patients had significantly higher von Willebrand factor antigen levels.
    • Basal levels of tissue-type plasminogen activator and PAI-1 were similar between groups.
    • Both groups showed increased tissue-type plasminogen activator after venous occlusion; D-dimer remained normal.

    Conclusions:

    • Fontan circulation is associated with potential endothelial dysfunction, evidenced by elevated von Willebrand factor.
    • Fibrinolysis appears to be maintained, indicated by a normal response to venous occlusion.
    • These findings highlight endothelial alterations in Fontan survivors.