Rubenis Imants, Tran Derek, Bullock Andrew, Wijesekera Vishva, Baker David, d'Udekem Yves, du Plessis Karin, Katz Darren, Lowy Michael, Zentner Dominica, Celermajer David, Cordina Rachael
Concord Repatriation General Hospital, Concord, NSW, Australia.
School of Medicine, The University of Sydney, Camperdown, NSW, Australia.
Front Pediatr. 2021 Nov 17;9:765380. doi: 10.3389/fped.2021.765380. eCollection 2021.
It is unknown if the Fontan circulation has an impact on sexual health in men. This study assessed self-reported sexual health and fertility in men with a Fontan circulation. In this prospective, cross-sectional study, Australian men ≥18 years enrolled in the Fontan Registry of Australia and New Zealand were invited to complete the International Index of Erectile Function (IIEF), alongside questions assessing fertility. These data were compared to historical, age-matched controls. Of 227 eligible men, 54 completed the survey; of those 37 were sexually active and included in the final analysis. Mean age was 28 ± 3 years, age at Fontan was 5 ± 3 years. Fontan type was extra-cardiac conduit in 15 (41%), lateral tunnel in 12 (32%), and atriopulmonary connection (APC) in 10 (27%). Ventricular function was normal in 24 (83%), and all were New York Heart Association Class I (23 patients, 79%) and II (six patients, 21%). Nine participants (24%) had erectile dysfunction (IIEF-EF score ≤25). The severity was mild (IIEF 22-24) in six (16%), mild-moderate (IIEF 17-21) in two (5%), and moderate (IIEF 11-16) in one (3%). Baseline characteristics and current medication usage were similar in those with and without erectile dysfunction. Compared with historical control values, erectile function was not significantly impaired in the Fontan population ( =0.76). Men with a Fontan circulation had decreased levels of sexual desire and overall satisfaction ( < 0.001). There was no correlation between the presence of erectile dysfunction and any assessed parameter. Eleven (30%) of the cohort reported a pregnancy with a prior partner. In our cohort, overall erectile function was comparable between men with a Fontan circulation and historical controls, however sexual desire and overall satisfaction were reduced. There was no correlation between study parameters and the presence of erectile dysfunction. The proportion of the cohort who had a prior pregnancy was congruent with population data.
尚不清楚Fontan循环是否会对男性的性健康产生影响。本研究评估了具有Fontan循环的男性自我报告的性健康和生育能力。在这项前瞻性横断面研究中，邀请了年龄≥18岁且登记在澳大利亚和新西兰Fontan登记处的澳大利亚男性完成国际勃起功能指数（IIEF），同时回答有关生育能力的问题。这些数据与历史上年龄匹配的对照组进行了比较。在227名符合条件的男性中，54人完成了调查；其中37人性活跃并纳入最终分析。平均年龄为28±3岁，接受Fontan手术时的年龄为5±3岁。Fontan类型为心外管道的有15例（41%），侧隧道的有12例（32%），心房肺连接（APC）的有10例（27%）。24例（83%）心室功能正常，且均为纽约心脏协会I级（23例患者，79%）和II级（6例患者，21%）。9名参与者（24%）有勃起功能障碍（IIEF-EF评分≤25）。严重程度为轻度（IIEF 22-24）的有6例（16%），轻度至中度（IIEF 17-21）的有2例（5%），中度（IIEF 11-16）的有1例（3%）。有和没有勃起功能障碍的患者的基线特征和当前用药情况相似。与历史对照值相比，Fontan人群的勃起功能没有明显受损（P=0.76）。具有Fontan循环的男性性欲和总体满意度水平降低（P<0.001）。勃起功能障碍的存在与任何评估参数之间均无相关性。该队列中有11名（30%）报告曾与前任伴侣怀孕。在我们的队列中，具有Fontan循环的男性与历史对照组的总体勃起功能相当，然而性欲和总体满意度降低。研究参数与勃起功能障碍的存在之间没有相关性。该队列中曾怀孕的比例与总体数据一致。
