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Altered endothelial function following the Fontan procedure

Published online by Cambridge University Press:  20 December 2007

Maria A. Binotto ,
Nair Y. Maeda  and
Antonio A. Lopes
Maria A. Binotto*
Affiliation:
Department of Paediatric Cardiology and Adult Congenital Heart Disease, Heart Institute (InCor)
Nair Y. Maeda
Affiliation:
Pró-Sangue Foundation, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil
Antonio A. Lopes
Affiliation:
Department of Paediatric Cardiology and Adult Congenital Heart Disease, Heart Institute (InCor)
*
Correspondence to: Dr Maria Angelica Binotto, Av Dr Eneas Carvalho de Aguiar, 44, 05403-000, São Paulo, Brazil. Tel/Fax: +55 11 30695409; E-mail: angelica.binotto@incor.usp.br
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Abstract

Objective

Thrombosis has been widely described after the Fontan procedure. The vascular endothelium plays a central role in the control of coagulation and fibrinolysis. The aim of this study was to investigate if patients undergoing a modified Fontan procedure have impaired endothelial function and fibrinolysis in the late postoperative course.

Patients and methods

We compared 23 patients aged from 7 to 26 years with age-matched healthy volunteers, collecting blood samples prior to and following standardized venous occlusion testing. Plasma levels of von Willebrand factor antigen, tissue-type plasminogen activator antigen, plasminogen activator inhibitor-1, and D-dimer were measured with enzyme-linked immunosorbent assay.

Results

We found increased plasma levels of von Willebrand factor antigen in patients when compared to controls (p = 0.003). At the basal condition, concentrations of tissue-type plasminogen activator antigen and plasminogen activator inhibitor-1 antigen in the plasma, as well as their activity, were not significantly different between patients and controls. Following venous occlusion, concentrations of tissue-type plasminogen activator antigen in the plasma were significantly increased both in patients and controls, compared to pre-occlusion values. D-dimer was within the reference range. Multivariate discriminant analysis differentiated patients and their controls on the basis of differences for plasminogen activator inhibitor-1 and von Willebrand factor antigen (p = 0.0016).

Conclusions

Our data suggest that patients with the Fontan circulation may have endothelial dysfunction, as indicated by raised levels of von Willebrand factor. Fibrinolysis seems to be relatively preserved, as suggested by appropriate response to venous occlusion.

Keywords

Functionally univentricular heartfibrinolysisthrombosis
Type
Original Article
Information
Cardiology in the Young , Volume 18 , Issue 1 , February 2008 , pp. 70 - 74
Copyright
Copyright © Cambridge University Press 2008

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