Early characteristics of bone deficits in children with Fontan palliation

Kyriakie Sarafoglou, Anna Petryk, Pooja E. Mishra, Lynda E. Polgreen, Angela Panoskaltsis-Mortari, Roland Brown, Bradley S. Marino, David Gremmels, Charles Shepard, Aaron S. Kelly, Bradley S. Miller, Kyle Rudser, Courtney McCracken, Lazaros K. Kochilas

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9 Scopus citations


Background:This is a cross-sectional study aiming to understand the early characteristics and background of bone health impairment in clinically well children with Fontan circulation.Methods:We enrolled 10 clinically well children with Fontan palliation (operated >5 years before study entrance, Tanner stage ≤3, age 12.1 ± 1.77 years, 7 males) and 11 healthy controls (age 12.0 ± 1.45 years, 9 males) at two children's hospitals. All patients underwent peripheral quantitative CT. For the Fontan group, we obtained clinical characteristics, NYHA class, cardiac index by MRI, dual x-ray absorptiometry, and biochemical studies. Linear regression was used to compare radius and tibia peripheral quantitative CT measures between Fontan patients and controls.Results:All Fontan patients were clinically well (NYHA class 1 or 2, cardiac index 4.85 ± 1.51 L/min/m2) and without significant comorbidities. Adjusted trabecular bone mineral density, cortical thickness, and bone strength index at the radius were significantly decreased in Fontan patients compared to controls with mean differences -30.13 mg/cm3 (p = 0.041), -0.31 mm (p = 0.043), and -6.65 mg2/mm4 (p = 0.036), respectively. No differences were found for tibial measures. In Fontan patients, the mean height-adjusted lumbar bone mineral density and total body less head z scores were -0.46 ± 1.1 and -0.63 ± 1.1, respectively, which are below the average, but within normal range for age and sex.Conclusions:In a clinically well Fontan cohort, we found significant bone deficits by peripheral quantitative CT in the radius but not the tibia, suggesting non-weight-bearing bones may be more vulnerable to the unique haemodynamics of the Fontan circulation.

Original languageEnglish (US)
JournalCardiology in the young
StatePublished - Apr 30 2020

Bibliographical note

Publisher Copyright:
© The Author(s), 2020. Published by Cambridge University Press.


  • Fontan circulation
  • bone mineral density
  • peripheral quantitative CT


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