Pediatric Cardiology

, Volume 34, Issue 1, pp 129–134 | Cite as

Sildenafil and Ventriculo-Arterial Coupling in Fontan-Palliated Patients: A Noninvasive Echocardiographic Assessment

  • Reza ShabanianEmail author
  • Leila Shahbaznejad
  • Anahita Razaghian
  • Abdolrazagh Kiani
  • Mitra Rahimzadeh
  • Soroush Seifirad
  • Armen Kocharian
  • Jami Shakibi Gilani
  • Mohammad Ali Navabi
Original Article


The fundamental role of pulmonary vascular resistance in the Fontan circulation is obvious. Medications decreasing this resistance may have an impact on the fate of this population. Hence, we assessed noninvasively the effect of oral sildenafil on the ventriculo-arterial coupling in patients with Fontan circulation. In a single-center, prospective case series study, 23 patients with fenestrated extracardiac total cavopulmonary connection age 12–31 years were enrolled in this study. Clinical characteristics and echocardiographic examination were performed before and after a 1 week course of sildenafil at 0.5 mg/kg every 8 h. Sildenafil had no effect on heart rate and blood pressure. However, oxygen saturation was significantly increased with sildenafil (87.6 ± 4.3 vs. 90.1 ± 3.6; P < 0.0001). The calculated noninvasive ventricular end-systolic elastance (Ees) was greater after sildenafil compared with the pre-sildenafil values (1.59 ± 0.17 vs. 1.72 ± 0.27 mm Hg/ml; P = 0.001). Moreover, significant decreases in arterial elastance (Ea) (1.62 ± 0.53 vs. 1.36 ± 0.43 mm Hg/ml; P < 0.0001), ventricular end-diastolic elastance (Eed) (0.05 ± 0.021 vs. 0.04 ± 0.013; P = 0.002), and, finally, ventriculo-arterial coupling index (0.99 ± 0.26 vs. 0.76 ± 0.15; P < 0.0001) were found after sildenafil administration. The intolerable side effects that led to stopping the sildenafil occurred only in one (4 %) patient. Sildenafil has increased ventricular systolic elastance and improved ventriculo-arterial coupling in patients palliated with Fontan circulation. Short-term sildenafil was well tolerated in most of the patients with only minor side effects.


Elastance Fontan Sildenafil Ventriculo-arterial coupling 


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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Reza Shabanian
    • 1
    Email author
  • Leila Shahbaznejad
    • 1
  • Anahita Razaghian
    • 1
  • Abdolrazagh Kiani
    • 1
  • Mitra Rahimzadeh
    • 2
  • Soroush Seifirad
    • 1
  • Armen Kocharian
    • 1
  • Jami Shakibi Gilani
    • 3
  • Mohammad Ali Navabi
    • 1
  1. 1.Department of Pediatric Cardiology, Children’s Medical CenterTehran University of Medical SciencesTehranIran
  2. 2.Department of BiostatisticsAlborz University Medical SciencesTehranIran
  3. 3.Department of Pediatric CardiologyDay General HospitalTehranIran

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