Ascending aortic dilation and aortic regurgitation - a neglected problem among single-ventricle patients after Fontan...

The Fontan procedure revolutionized the management of univentricular heart physiology but is associated with long-term complications. Although pulmonary vascular disease, atrioventricular valve regurgitation, and ventricular dysfunction are well-recognized risks, aortic dilation and aortic regurgitation (AR) are emerging concerns. This study aimed to assess the prevalence and risk factors for aortic dilation and AR in adult post-Fontan patients.

We retrospectively analyzed 101 single-ventricle patients who underwent Fontan palliation and were hospitalized at NIKARD between 2013 and 2022. Echocardiographic data were reviewed for aortic dimensions and AR severity using Doppler techniques and quantitative parameters. Statistical analyses included parametric and nonparametric tests (p < 0.05).

Of 101 patients (52 male), 13.8% had moderate/severe AR. Aortic root dilation (≥ 45 mm) was observed in 12 patients; 17 had an ascending aortic diameter > 36 mm. The mean aortic root and ascending aortic diameters were 36.9 mm and 32.4 mm, respectively. Older age at Fontan palliation was an independent risk factor for AR and aortic dilation. Patients with a lateral tunnel Fontan had a threefold higher risk of AR (OR 3.19, p = 0.020), while prior Blalock-Taussig shunt and diagnoses such as double-inlet left ventricle (DILV), double-outlet right ventricle (DORV), or hypoplastic right heart syndrome (HRHS) also increased risk. Single-ventricle morphology showed no significant association.

Aortic dilation and AR are notable late complications after Fontan palliation. Regular long-term imaging follow-up is recommended to monitor aortic pathology.