Hostname: page-component-78c5997874-t5tsf Total loading time: 0 Render date: 2024-11-19T15:45:27.620Z Has data issue: false hasContentIssue false
  • English
  • Français

Exercise capacity reflects ventricular function in patients having the Fontan circulation

Published online by Cambridge University Press:  01 August 2009

Katrin Klimes ,
Stanislav Ovroutski ,
Hashim Abdul-Khaliq ,
Peter Ewert ,
Vladimir Alexi-Meskishvili ,
Titus Kuehne ,
Matthias Gutberlet  and
Felix Berger
Katrin Klimes*
Affiliation:
Departments of 1Congenital Heart Defects/Pediatric Cardiology, Deutsches Herzzentrum Berlin,
Stanislav Ovroutski
Affiliation:
Departments of 1Congenital Heart Defects/Pediatric Cardiology, Deutsches Herzzentrum Berlin,
Hashim Abdul-Khaliq
Affiliation:
Pediatric Cardiology, Universität des Saarlandes,
Peter Ewert
Affiliation:
Departments of 1Congenital Heart Defects/Pediatric Cardiology, Deutsches Herzzentrum Berlin,
Vladimir Alexi-Meskishvili
Affiliation:
Thoracic and Cardiovascular Surgery, Deutsches Herzzentrum Berlin, and
Titus Kuehne
Affiliation:
Departments of 1Congenital Heart Defects/Pediatric Cardiology, Deutsches Herzzentrum Berlin,
Matthias Gutberlet
Affiliation:
Diagnostic and Interventional Radiology, Herzzentrum Leipzig, Germany
Felix Berger
Affiliation:
Departments of 1Congenital Heart Defects/Pediatric Cardiology, Deutsches Herzzentrum Berlin,
*
Correspondence to: Katrin Klimes, MD, Department of Congenital Heart Defects/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353 Berlin, Germany. Tel: +49-30-4593-2800; Fax: +49-30-4593-2900; E-mail: klimes@dhzb.de
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

In this study we sought to determine, first, whether maximal exercise capacity reflects ventricular function, and second, whether the age of the patient, and the age of completion of the Fontan circulation, influence ventricular function and exercise performance.

Methods and Results

Cardiac magnetic resonance imaging and cardiopulmonary exercise testing were performed in 29 patients at a median time of 6.9 years after completion of the Fontan circulation. We divided the patients into 2 groups, the first 19 having their operation below the age of 18 years, and the second group, of 10 patients, having completion of the Fontan circulation when they were older than 18 years. Parameters for ventricular function and exercise were compared for both groups with controls.

Compared to controls, the younger patients had normal end-diastolic ventricular volumes, but significantly impaired ventricular function, lower maximal work load and consumption of oxygen. The older patients had greater end-diastolic ventricular volumes, and significantly poorer ventricular function than both the younger patients and the controls. Maximal work load and consumption of oxygen were significantly lower in the older patients than in the younger ones and the controls.

Conclusion

Patients with the Fontan circulation have an impaired systolic ventricular function, which correlates with maximal exercise capacity and uptake of oxygen. Those having completion of the Fontan circulation when younger than 18 years had significantly better ventricular function and exercise performance than those who had completion of the Fontan circulation at an older age. An early creation of the Fontan circulation may preserve cardiac function and exercise capacity.

Keywords

Functionally univentricular heartcavopulmonary connectioncongenital heart disease
Type
Original Articles
Information
Cardiology in the Young , Volume 19 , Issue 4 , August 2009 , pp. 340 - 345
Copyright
Copyright © Cambridge University Press 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Fontan, F, Baudet, E. Surgical repair of tricuspid atresia. Thorax 1971; 26: 240–248.Google Scholar
2Kreutzer, G, Galindez, E, Bono, H, De Palma, C, Laura, JP. An operation for the correction of tricuspid atresia. J Thorac Cardiovasc Surg 1973; 66: 613–621.CrossRefGoogle ScholarPubMed
3Klimes, K, Abdul-Khaliq, H, Ovroutski, S, et al. Pulmonary and caval blood flow patterns in patients with intracardiac and extracardiac Fontan: a magnetic resonance study. Clin Res Cardiol 2006; 96: 160–167.CrossRefGoogle Scholar
4Gutberlet, M, Hosten, N, Abdul-Khaliq, H, et al. [The value of magnetic resonance tomography (MRT) for evaluating ventricular and anastomotic functions in patients with an extra- or intracardiac total cavopulmonary connection (TCPC)-modified Fontan operation]. Rofo 1999; 171: 431–441.Google Scholar
5Hjortdal, VE, Emmertsen, K, Stenbog, E, et al. Effects of exercise and respiration on blood flow in total cavopulmonary connection: a real-time magnetic resonance flow study. Circulation 2003; 108: 1227–1231.Google Scholar
6Rebergen, SA, Ottenkamp, J, Doornbos, J, van der Wall, EE, Chin, JG, de Roos, A. Postoperative pulmonary flow dynamics after Fontan surgery: assessment with nuclear magnetic resonance velocity mapping. J Am Coll Cardiol 1993; 21: 123–131.Google Scholar
7Fogel, MA, Weinberg, PM, Rychik, J, et al. Caval contribution to flow in the branch pulmonary arteries of Fontan patients with a novel application of magnetic resonance presaturation pulse. Circulation 1999; 99: 1215–1221.Google Scholar
8Eicken, A, Fratz, S, Gutfried, C, et al. Hearts late after Fontan operation have normal mass, normal volume, and reduced systolic function: a magnetic resonance imaging study. J Am Coll Cardiol 2003; 42: 1061–1065.Google Scholar
9Piran, S, Veldtman, G, Siu, S, Webb, GD, Liu, PP. Heart failure and ventricular dysfunction in patients with single or systemic right ventricles. Circulation 2002; 105: 1189–1194.Google Scholar
10Veldtman, GR, Nishimoto, A, Siu, S, et al. The Fontan procedure in adults. Heart 2001; 86: 330–335.Google Scholar
11Ohuchi, H, Hamamichi, Y, Hayashi, T, et al. Post-exercise heart rate, blood pressure and oxygen uptake dynamics in pediatric patients with Fontan circulation Comparison with patients after right ventricular outflow tract reconstruction. Int J Cardiol 2005; 101: 129–136.CrossRefGoogle ScholarPubMed
12Ohuchi, H, Arakaki, Y, Hiraumi, Y, Tasato, H, Kamiya, T. Cardiorespiratory response during exercise in patients with cyanotic congenital heart disease with and without a Fontan operation and in patients with congestive heart failure. Int J Cardiol 1998; 66: 241–251.CrossRefGoogle ScholarPubMed
13Harrison, DA, Liu, P, Walters, JE, et al. Cardiopulmonary function in adult patients late after Fontan repair. J Am Coll Cardiol 1995; 26: 1016–1021.Google Scholar
14Rosenthal, M, Bush, A, Deanfield, J, Redington, A. Comparison of cardiopulmonary adaptation during exercise in children after the atriopulmonary and total cavopulmonary connection Fontan procedures. Circulation 1995; 91: 372–378.CrossRefGoogle ScholarPubMed
15Gewillig, MH, Lundstrom, UR, Bull, C, Wyse, RK, Deanfield, JE. Exercise responses in patients with congenital heart disease after Fontan repair: patterns and determinants of performance. J Am Coll Cardiol 1990; 15: 1424–1432.Google Scholar
16Cook, AC, Anderson, RH. The functionally univentricular circulation: anatomic substrates as related to function. Cardiol Young 2005; 15 Suppl 3: 7–16.Google Scholar
17Yeh, T Jr.Williams, WG, McCrindle, BW, et al. Equivalent survival following cavopulmonary shunt: with or without the Fontan procedure. Eur J Cardiothorac Surg 1999; 16: 111–116.Google Scholar
18Niepage, S, Schulze-Neick, I, Rechter, S, et al. [Influence of myocardial mass of the univentricular heart on exercise capacity in patients with functional single ventricle and Fontan surgery]. Z Kardiol 2004; 93: 222–228.CrossRefGoogle ScholarPubMed