| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 1995;91:372-378.)
© 1995 American Heart Association, Inc.
Articles |
Comparison of Cardiopulmonary Adaptation During Exercise in Children After the Atriopulmonary and Total Cavopulmonary Connection Fontan Procedures
From the Departments of Paediatric Respiratory Medicine (M.R., A.B.) and Cardiology (A.R.), The Royal Brompton National Heart and Lung Hospital, and the Cardiothoracic Unit, The Hospital for Sick Children (J.D.), London, U.K.
Correspondence to Andrew Redington, The Royal Brompton National Heart and Lung Hospital, Sydney Street, London SW3 6NP, UK.
Background There are several potential physiological differences between the atriopulmonary (AP) and the total cavopulmonary connection (TCPC) Fontan circulations. Studies suggest that the TCPC reduces energy loss due to turbulence and may have more dependence on respiratory movement for pulmonary blood flow. We compared cardiopulmonary physiology during rest and exercise in patients who had undergone the AP Fontan procedure with those who had undergone the TCPC Fontan procedure.
Methods and Results Forty-three children were studied more than 6 months after undergoing a Fontan procedure (23 AP and 20 TCPC); 106 healthy children were also studied as a control group. Measurements of effective pulmonary blood flow, stroke volume, arteriovenous oxygen difference, minute ventilation, heart rate, and oxygen and carbon dioxide consumption were made with an Innovision quadrupole mass spectrometer. Data from the control group allowed calculation of z scores for the Fontan groups matched for age, sex, pubertal stage, and body surface area. Maximal exercise performance was equal in the two Fontan groups, but it was below normal. However, adaptation to exercise was different in the Fontan groups. After 9 minutes of exercise, pulmonary blood flow rose less in the AP group than in the TCPC group (P<.01), and the stroke volume in the AP group also tended to be lower (P=.057) and their arteriovenous oxygen difference was significantly greater (P<.01). Although minute ventilation per unit of carbon dioxide production was similar in the Fontan groups at this level of exercise, children in the TCPC group breathed faster by approximately 10 breaths per minute (P<.005).
Conclusions At submaximal exercise, children who had undergone the TCPC Fontan procedure had pulmonary hemodynamics superior to those of children who had undergone the AP procedure, largely because of respiratory adaptation that permitted blood to be "sucked" into the lungs. To achieve the same maximal exercise performance, children who had undergone the AP procedure had a superior metabolic adaptation to exercise stress.
Key Words: surgery • pediatrics • spectrometry • exercise
This article has been cited by other articles:
 |
|
 |
|
  Y. d'Udekem, M. M.H. Cheung, S. Setyapranata, A. J. Iyengar, P. Kelly, N. Buckland, L. E. Grigg, R. G. Weintraub, A. Vance, C. P. Brizard, et al. How Good Is a Good Fontan? Quality of Life and Exercise Capacity of Fontans Without Arrhythmias Ann. Thorac. Surg., December 1, 2009; 88(6): 1961 - 1969. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Itatani, K. Miyaji, T. Tomoyasu, Y. Nakahata, K. Ohara, S. Takamoto, and M. Ishii Optimal conduit size of the extracardiac Fontan operation based on energy loss and flow stagnation. Ann. Thorac. Surg., August 1, 2009; 88(2): 565 - 572. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. K. Whitehead, K. S. Sundareswaran, W. J. Parks, M. A. Harris, A. P. Yoganathan, and M. A. Fogel Blood flow distribution in a large series of patients having the Fontan operation: A cardiac magnetic resonance velocity mapping study J. Thorac. Cardiovasc. Surg., July 1, 2009; 138(1): 96 - 102. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Z. Yin, C. Wang, H. Zhu, R. Zhang, H. Wang, and X. Li Exercise Tolerance in Extracardiac Total Cavopulmonary Connection Asian Cardiovasc Thorac Ann, January 1, 2009; 17(1): 39 - 44. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Giardini, A. Balducci, S. Specchia, G. Gargiulo, M. Bonvicini, and F. M. Picchio Effect of sildenafil on haemodynamic response to exercise and exercise capacity in Fontan patients Eur. Heart J., July 1, 2008; 29(13): 1681 - 1687. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. E. Hjortdal, T. D. Christensen, S. H. Larsen, K. Emmertsen, and E. M. Pedersen Caval Blood Flow During Supine Exercise in Normal and Fontan Patients Ann. Thorac. Surg., February 1, 2008; 85(2): 599 - 603. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. K. Whitehead, K. Pekkan, H. D. Kitajima, S. M. Paridon, A. P. Yoganathan, and M. A. Fogel Nonlinear Power Loss During Exercise in Single-Ventricle Patients After the Fontan: Insights From Computational Fluid Dynamics Circulation, September 11, 2007; 116(11_suppl): I-165 - I-171. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Giannico, F. Hammad, A. Amodeo, G. Michielon, F. Drago, A. Turchetta, R. Di Donato, and S. P. Sanders Clinical Outcome of 193 Extracardiac Fontan Patients: The First 15 Years J. Am. Coll. Cardiol., May 16, 2006; 47(10): 2065 - 2073. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Y. Tanoue, M. Masuda, M. Eto, and R. Tominaga Venous cannulation for extracorporeal circulation after total cavopulmonary connection with extracardiac conduit Interactive CardioVascular and Thoracic Surgery, February 1, 2006; 5(1): 9 - 10. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E.A. Edwards, I. Narang, A. Li, D.M. Hansell, M. Rosenthal, and A. Bush HRCT lung abnormalities are not a surrogate for exercise limitation in bronchiectasis Eur. Respir. J., October 1, 2004; 24(4): 538 - 544. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Nakano, H. Kado, S. Ishikawa, Y. Shiokawa, H. Ushinohama, K. Sagawa, N. Fusazaki, Y. Nishimura, Y. Tanoue, T. Nakamura, et al. Midterm surgical results of total cavopulmonary connection: clinical advantages of the extracardiac conduit method J. Thorac. Cardiovasc. Surg., March 1, 2004; 127(3): 730 - 737. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V.E. Hjortdal, K. Emmertsen, E. Stenbog, T. Frund, M. R. Schmidt, O. Kromann, K. Sorensen, and E.M. Pedersen Effects of Exercise and Respiration on Blood Flow in Total Cavopulmonary Connection: A Real-Time Magnetic Resonance Flow Study Circulation, September 9, 2003; 108(10): 1227 - 1231. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Szabo, V. Buhmann, A. Graf, S. Melnitschuk, S. Bahrle, C. F. Vahl, and S. Hagl Ventricular energetics after the Fontan operation: Contractility-afterload mismatch J. Thorac. Cardiovasc. Surg., May 1, 2003; 125(5): 1061 - 1069. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E M Pedersen, E V Stenbog, T Frund, K Houlind, O Kromann, K E Sorensen, K Emmertsen, and V E Hjortdal Flow during exercise in the total cavopulmonary connection measured by magnetic resonance velocity mapping Heart, June 1, 2002; 87(6): 554 - 558. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Ohuchi, K. Yasuda, S. Hasegawa, A. Miyazaki, M. Takamuro, O. Yamada, Y. Ono, H. Uemura, T. Yagihara, and S. Echigo Influence of ventricular morphology on aerobic exercise capacity in patients after the Fontan operation J. Am. Coll. Cardiol., June 1, 2001; 37(7): 1967 - 1974. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V E Hjortdal, E V Stenbøg, H B Ravn, K Emmertsen, K T Jensen, E B Pedersen, K H Olsen, O K Hansen, and K E Sørensen Neurohormonal activation late after cavopulmonary connection Heart, April 1, 2000; 83(4): 439 - 443. [Abstract] [Full Text]
|
|
|
|
|
|
W. T. Mahle, G. Wernovsky, N. D. Bridges, A. B. Linton, and S. M. Paridon Impact of early ventricular unloading on exercise performance in preadolescents with single ventricle fontan physiology J. Am. Coll. Cardiol., November 1, 1999; 34(5): 1637 - 1643. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Be'eri, S. E. Maier, M. J. Landzberg, T. Chung, and T. Geva In Vivo Evaluation of Fontan Pathway Flow Dynamics by Multidimensional Phase-Velocity Magnetic Resonance Imaging Circulation, December 22, 1998; 98(25): 2873 - 2882. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. S. Shekerdemian, A. Bush, D. F. Shore, C. Lincoln, and A. N. Redington Cardiopulmonary Interactions After Fontan Operations : Augmentation of Cardiac Output Using Negative Pressure Ventilation Circulation, December 2, 1997; 96(11): 3934 - 3942. [Abstract] [Full Text]
|
|
|
|
|
|
A. A. Kouatli, J. A. Garcia, T. M. Zellers, E. M. Weinstein, and L. Mahony Enalapril Does Not Enhance Exercise Capacity in Patients After Fontan Procedure Circulation, September 2, 1997; 96(5): 1507 - 1512. [Abstract] [Full Text]
|
|
|
|
|
|
J.-M. Van Haesdonck, L. Mertens, R. Sizaire, G. Montas, B. Purnode, W. Daenen, M. Crochet, and M. Gewillig Comparison by Computerized Numeric Modeling of Energy Losses in Different Fontan Connections Circulation, November 1, 1995; 92(9): 322 - 326. [Abstract] [Full Text]
|
|