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(Circulation. 2003;108:1227.)
© 2003 American Heart Association, Inc.

Clinical Investigation and Reports

Effects of Exercise and Respiration on Blood Flow in Total Cavopulmonary Connection

A Real-Time Magnetic Resonance Flow Study

V.E. Hjortdal, MD, DMSc; K. Emmertsen, MD, DMSc; E. Stenbøg, MD, PhD; T. Fründ, MSc; M. Rahbek Schmidt, MD; O. Kromann, MD; K. Sørensen, MD; E.M. Pedersen, MD, DMSc

From the Department of Cardiothoracic and Vascular Surgery (V.E.H., E.S., O.K.), MR Center, Institute of Experimental Clinical Research (T.F., E.M.P.), and Department of Cardiology (K.E., M.R.S., K.S., E.M.P.), Skejby Hospital, Aarhus University Hospital, Aarhus, Denmark.

Correspondence to Vibeke E. Hjortdal, MD, DMSc, PhD, Department of Cardiothoracic and Vascular Surgery, Skejby Hospital, Aarhus University Hospital, DK-8200 Aarhus N, Denmark. E-mail vibeke.hjortdal{at}dadlnet.dk

Received February 24, 2003; revision received June 10, 2003; accepted June 11, 2003.

Background— Little is known about blood flow and its relationship to respiration during exercise in patients with total cavopulmonary connection (TCPC).

Methods and Results— We studied 11 patients 12.4±4.6 years (mean±SD) of age 5.9±2.8 years (mean±SD) after TCPC operation. Real-time MRI was used to measure blood flow in the superior vena cava (SVC), inferior vena cava (IVC), and ascending aorta under inspiration and expiration during supine lower-limb exercise (rest, 0.5 and 1.0 W/kg) on an ergometer bicycle. IVC and aortic flow increased from 1.60±0.52 and 2.99±0.83 L/min per m² at rest to 2.58±0.71 and 3.97±1.20 L/min per m² at 0.5 W/kg and to 3.25±1.23 and 4.62±1.49 L/min per m² at 1.0 W/kg (P0.05). SVC flow remained unchanged. Resting flow in the IVC was greater during inspiration (2.99±1.25 L/min per m²) than during expiration (0.83±0.44 L/min per m²) (inspiratory/mean flow ratio, 1.9±0.5), and retrograde flow was present during expiration (11±12% of mean flow). The predominance of inspiratory flow in IVC diminished with exercise to an inspiratory/mean flow ratio of 1.5±0.2 (P0.05) and 1.4±0.3 at 0.5 and 1.0 W/kg, respectively.

Conclusions— In the TCPC, circulation IVC and aortic but not SVC flows increase with supine leg exercise. Inspiration facilitates IVC flow at rest but less so during exercise, when the peripheral pump seems to be more important.

Key Words: exercise • Fontan procedure • magnetic resonance imaging • heart defects, congenital

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