Pediatric Cardiology

, 30:138

Serum Alkaline Phosphatase Reflects Post-Fontan Hemodynamics in Children

  • Alvin J. Chin
  • P. Stephens
  • E. Goldmuntz
  • M. B. Leonard
Original Article

Abstract

Although survivors of Fontan palliation for a single ventricle are known to have lower cardiac index than patients with two-ventricle surgical reconstructions, it is unclear whether two frequently observed sequelae, short stature and protein-losing enteropathy (PLE), have hemodynamic origins. A serum marker that reflects hemodynamic status would be a tremendous asset in the long-term management of children with these sequelae. The authors recently noted severely reduced total alkaline phosphatase (TALP) levels in two children with early-onset PLE after Fontan operations, both of whom had low cardiac output at cardiac catheterization. Catheter-based or surgical interventions that rapidly increased cardiac output in these two patients resulted not only in relief of PLE but also in a prompt TALP rise. To examine whether the apparent correlation of low TALP with impaired cardiac output also is seen in Fontan patients without PLE, this study retrospectively examined the TALP data from two other Fontan patients who underwent cardiac catheterization specifically to assess the potential benefit of vasodilator therapy. The TALP levels were abnormally low in both cases but increased after uptitration of angiotensin-converting enzyme inhibition. Serum TALP activity, an indicator of osteoblastic function particularly in preadolescence, may be a marker of low cardiac output after a Fontan operation.

Keywords

Fontan Bone Cardiac output Alkaline phosphatase Osteoblast Single ventricle 

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Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Alvin J. Chin
    • 1
    • 4
  • P. Stephens
    • 2
  • E. Goldmuntz
    • 3
    • 4
  • M. B. Leonard
    • 4
    • 5
  1. 1.Division of Cardiology, Abramson Research CenterThe Children’s Hospital of PhiladelphiaPhiladelphiaUSA
  2. 2.Division of CardiologyThe Children’s Hospital of PhiladelphiaPhiladelphiaUSA
  3. 3.Division of Cardiology, Abramson Research CenterThe Children’s Hospital of PhiladelphiaPhiladelphiaUSA
  4. 4.Department of PediatricsUniversity of Pennsylvania School of MedicinePhiladelphiaUSA
  5. 5.Division of NephrologyThe Children’s Hospital of PhiladelphiaPhiladelphiaUSA

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