Abstract 18452: Importance of “Dynamic” Rather Than “Static” Central Venous Pressure and Venous Capacitance in Fontan Circulation During Exercise
Background: High central venous pressure (CVP) is a key driver of developing late complications in patients after Fontan operation. However, we often realize diversity of clinical outcome among patients with similar levels of CVP measured at resting condition during catheterization. We hypothesized that CVP variably increases with exercise and that degree of the increase is associated with clinical outcomes. We also hypothesized that venous capacitance (VC) is an important determinant of the CVP elevation.
Methods: Dynamic changes in CVP estimated from continuous monitoring of peripheral venous pressure were measured during treadmill exercise (TM) in 21 Fontan patients and 10 age-matched control patients with biventricular (BV) circulation. The VC was calculated during temporal occlusion of inferior vena cava (IVC) at the time of catheterization.
Results: Fontan patients exhibited significantly shorter duration of exercise with limited increases in heart rate and cardiac output. CVP significantly increased during exercise in both groups, but the degree of CVP elevation was much higher in Fontan patients than in controls (Fontan: from 10.8 to 18.4 mmHg vs. control: from 4.3 to 8.8 mmHg, P<0.05). Importantly, maximum CVP during exercise in Fontan group varied considerably among patients with similar resting CVP, and is significantly and positively correlated with a liver fibrosis marker of type 4 collagen 7S (P <0.01). Furthermore, maximum CVP during exercise in Fontan group negatively correlated with the VC, but not with pulmonary resistance.
Conclusions: CVP of the Fontan circulation easily rises during exercise in proportion to the reduced VC, and the degree of CVP rise may be a contributor of hepatic complication. These results suggest the importance of assessing dynamic CVP in patients after Fontan operation. The results also suggest potential importance of daily life modification and/or medical treatment to minimize the dynamic changes in CVP to improve the prognosis of Fontan patients. VC may be a viable target for this purpose.
Author Disclosures: C. Kurishima: None. S. Kuwata: None. Y. Iwamoto: None. H. Ishido: None. S. Masutani: None. H. Senzaki: None.
- © 2015 by American Heart Association, Inc.