Pediatric Cardiology

, Volume 33, Issue 5, pp 689–696

Impact of Sildenafil on Echocardiographic Indices of Myocardial Performance After the Fontan Operation

  • David J. Goldberg
  • Benjamin French
  • Anita L. Szwast
  • Michael G. McBride
  • Bradley S. Marino
  • Nicole Mirarchi
  • Brian D. Hanna
  • Gil Wernovsky
  • Stephen M. Paridon
  • Jack Rychik
Original Article

DOI: 10.1007/s00246-012-0196-9

Cite this article as:
Goldberg, D.J., French, B., Szwast, A.L. et al. Pediatr Cardiol (2012) 33: 689. doi:10.1007/s00246-012-0196-9

Abstract

The objective of this study was describe the impact of sildenafil on echocardiographic measures of myocardial performance in children and young adults with a functional single-ventricle physiology late after Fontan surgery. A double-blind, placebo-controlled, crossover trial was conducted in children and young adults after the Fontan operation at a single pediatric center. Subjects were randomized to receive placebo or sildenafil (20 mg tid) for 6 weeks. After a 6-week washout period, subjects were crossed for an additional 6 weeks. Each subject underwent an echocardiogram at the start and finish of each phase. A total of 27 subjects completed study testing at a mean age of 14.9 years and a mean time from Fontan surgery of 11.3 years. After sildenafil, subjects demonstrated improvement in their myocardial performance index (MPI; −0.051; 95% CI −0.095, −0.0077; p 0.02) and in the product of the velocity time integral (VTI) of the dominant outflow tract and the heart rate (HR; 110 cm × bpm; 95% CI 7.5, 220; p = 0.04). Measures of diastolic performance, including inflow velocities, myocardial velocities, and the ratio of blood pool velocity to myocardial velocity during passive inflow, did not change. In this cohort, there were significant improvements in both the MPI and the product of the VTI × HR after 6 weeks of treatment with sildenafil. These findings suggest that sildenafil may be a useful therapy to improve or maintain ventricular performance in select patients after the Fontan operation.

Keywords

Fontan procedure Echocardiography Physiology Trials Sildenafil 

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • David J. Goldberg
    • 1
    • 2
  • Benjamin French
    • 3
  • Anita L. Szwast
    • 1
    • 2
  • Michael G. McBride
    • 1
  • Bradley S. Marino
    • 4
  • Nicole Mirarchi
    • 1
  • Brian D. Hanna
    • 1
    • 2
  • Gil Wernovsky
    • 1
    • 2
  • Stephen M. Paridon
    • 1
    • 2
  • Jack Rychik
    • 1
    • 2
  1. 1.Division of CardiologyThe Children’s Hospital of PhiladelphiaPhiladelphiaUSA
  2. 2.Department of Pediatrics, The Perelman School of MedicineThe University of PennsylvaniaPhiladelphiaUSA
  3. 3.Department of Biostatistics and Epidemiology, The Perelman School of MedicineThe University of PennsylvaniaPhiladelphiaUSA
  4. 4.Divisions of Cardiology and Critical Care MedicineCincinnati Children’s Hospital Medical CenterCincinnatiUSA