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Atrial remodeling after the Fontan operation.

Cordula M Wolf1, Stephen P Seslar, Karen den Boer

  • 1Department of Pediatrics, Harvard Medical School, Boston, MA, USA.

The American Journal of Cardiology
|December 8, 2009
PubMed
Summary

Fontan surgery leads to thicker atria (RA and LA) in patients with single ventricle physiology. This atrial remodeling, characterized by increased wall thickness, does not appear to be solely due to fibrosis and may not hinder arrhythmia treatments.

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Area of Science:

  • Cardiology
  • Pediatric Cardiology
  • Cardiac Surgery

Background:

  • Hemodynamics post-Fontan surgery often involve hypertension and right atrial (RA) dilation.
  • The impact of these hemodynamic changes on atrial cytoarchitecture and potential links to arrhythmias remain understudied.

Purpose of the Study:

  • To investigate atrial remodeling in Fontan hearts by analyzing morphologic and histopathologic changes.
  • To compare atrial wall thickness and fibrosis in Fontan specimens versus controls with normal hemodynamics.

Main Methods:

  • Morphologic and histopathologic analysis of RA and LA autopsy specimens from 47 Fontan hearts and 15 controls.
  • Assessment of atrial wall thickness, fibrosis content, and fibrosis pattern.

Main Results:

  • Fontan hearts showed significantly increased RA and LA wall thickness compared to controls (p <0.001 and p = 0.024).
  • RA thickening correlated with older age at surgery, older age at death, and longer duration of Fontan circulation.
  • Fibrosis patterns were similar in both Fontan and control atria, suggesting it's not a specific response to Fontan hemodynamics.

Conclusions:

  • Atrial remodeling after Fontan surgery involves increased wall thickness in both RA and LA.
  • Observed interstitial fibrosis in Fontan atria likely represents normal structure, not a specific hemodynamic response.
  • The degree of atrial wall thickening is unlikely to impede transmural lesion creation for arrhythmia ablation.