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Cardiopulmonary reponse to exercise after the Fontan Operation—a cross-sectional and longitudinal evaluation

Published online by Cambridge University Press:  19 August 2008

Luc Mertens ,
Ralph Rogers ,
Tony Reybrouck ,
Monique Dumoulin ,
Luc Vanhees  and
Marc Gewillig
Luc Mertens
Affiliation:
From the Departments of Pediatric Cardiology and Cardiovascular Rehabilitation, Gasthuisberg University Hospital, University of Leuven (K.U.Leuven), Leuven, Belgium
Ralph Rogers
Affiliation:
From the Departments of Pediatric Cardiology and Cardiovascular Rehabilitation, Gasthuisberg University Hospital, University of Leuven (K.U.Leuven), Leuven, Belgium
Tony Reybrouck
Affiliation:
From the Departments of Pediatric Cardiology and Cardiovascular Rehabilitation, Gasthuisberg University Hospital, University of Leuven (K.U.Leuven), Leuven, Belgium
Monique Dumoulin
Affiliation:
From the Departments of Pediatric Cardiology and Cardiovascular Rehabilitation, Gasthuisberg University Hospital, University of Leuven (K.U.Leuven), Leuven, Belgium
Luc Vanhees
Affiliation:
From the Departments of Pediatric Cardiology and Cardiovascular Rehabilitation, Gasthuisberg University Hospital, University of Leuven (K.U.Leuven), Leuven, Belgium
Marc Gewillig*
Affiliation:
From the Departments of Pediatric Cardiology and Cardiovascular Rehabilitation, Gasthuisberg University Hospital, University of Leuven (K.U.Leuven), Leuven, Belgium
*
Dr Marc Gewilling Department of Pediatric Cardiology, University Hospital Gasthuisberg, Heresttaat 49, B-3000 Leuven, Belgium. Tel. 32-16-343865; Fax. 32-16-343981.
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Abstract

The purpose of this study was to assess cardiorespiratory responses to submaximal exercise in patients with univentricular atrioventricular connection after the Fontan operation, and to evaluate whether changes occur during medium-term follow-up. Eighteen patients (age 12.1±5.5 years) underwent graded exercise test on a treadmill 2.3±1.4 year after the Fontan repair. Ventilatory gases were measured using breath-by-breath analysis. Results were compared to gender/age-matched controls. Twelve patients (age 14.2±5.4 years) were reevaluated 2.4±2.1 years after the first test. Aerobic exercise performance was subnormal in all patients during the first test. At the lowest level of exercise, the ventilatory threshold was already surpassed in 6/18 patients, while it was reduced in all other patients (p<0.001). All patients were in stable sinus rhythm throughout the test. Heart rate at all exercise levels was ±10% below normal (p<0.05). The respiratory frequency was increased at all exercise levels (p<0.001). The ventilatory equivalent for oxygen was increased (p<0.001), and the end-tidal tension of carbon dioxide was decreased (p<0.001). The ratio of physiological dead space/tidal volume was increased in all patients (p<0.001), while the normal decrease of this ratio during exercise was not observed. Upon reevaluation heart rate, respiratory rate, oxygen uptake, venti latory equivalent for oxygen, end-tidal carbon dioxide tension and physiological dead space did not change signifi cantly. Only a slight further decrease in ventilatory threshold was observed. Aerobic performance after the Fontan procedure ranges widely from just above resting metabolic rate to the lower limit of normal. Dyspnea during exercise is exacerbated by a decreased ventilatory threshold, increased physiological dead space, and decreased respir-atory efficiency. Cardiorespiratory response to exercise, nonetheless, remains relatively stable during medium-term follow-up.

Keywords

Exercise testingcongenital heart diseaseFontan operation
Type
Original Manuscripts
Information
Cardiology in the Young , Volume 6 , Issue 2 , April 1996 , pp. 136 - 142
Copyright
Copyright © Cambridge University Press 1996

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References

1.Driscoll, DJ, Danielson, GK, Puga, FJ, Schaff, HV, Heise, CT, Staats, BA. Exercise tolerance and cardiorespiratory response to exercise after the Fontan operation for tricuspid atresia or functional single ventricle. J Am Coll Cardiol 1986; 7: 1087–1094.CrossRefGoogle ScholarPubMed
2.Ben, Sachar G, Fuhrman, BP, Wang, Y, Lucas, RVJr, Lock, JE. Rest and exercise dynamics after the Fontan procedure. Circulation 1982; 65: 1043–1048.Google Scholar
3.Gewillig, MH, Lundstrom, UR, Bull, C, Wyse, RK, Deanfleld, 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.CrossRefGoogle ScholarPubMed
4.Amiram, Nir, Driscoll, DJ, Mottram, CD, Offord, KP, Puga, FJ, Schaff, HV, Danielson, GK. Cardiorespiratory response to exercise after the Fontan operation: a serial study. J Am Coll Cardiol 1993; 22: 216–220.Google Scholar
5.Grant, GP, Mansell, AL, Garofano, RP, Hayes, CJ, Bowman, FO, Gersony, WM. Cardiorepiratory response to exercise after the Fontan procedure for tricuspid atresia. Pediatr Res 1988; 24: 1–5.CrossRefGoogle Scholar
6.Reybrouck, T, Weymans, M, Stijns, H, Van der, Hauwaert LG. Exercise testing after correction of tetralogy of Fallot: the fallacy of a reduced heart rate response. Am Heart J 1986; 112: 998–1003.CrossRefGoogle ScholarPubMed
7.Reybrouck, T, Deroost, F, Van der, Hauwaert LG. Evaluation of breath-by-breath measurement of respiratory gas exchange in pediatric exercise testing. Chest 1992; 102: 147–155.CrossRefGoogle ScholarPubMed
8.Wasserman, K, Hanssen, JE, Sue, DY, Whipp, BJ, Casaburi, R. Principles of Exercise Testing and Interpretation. Lea and Febiger, Philadelphia, 1994.Google Scholar
9.Jones, NL, Robertson, DG, Kane, JW. Differences between end-tidal and arterial pCO2, during exercise. J Appl Physiol 1979; 47: 954–960.CrossRefGoogle Scholar
10.Wasserman, K. Determinants and detection ofanaerobic threshold and consequences of exercise above it. Circulation 1987; 76(Suppl VI): V129–V139Google Scholar
11.Dickstein, K, Barvik, S, Aarsland, T, Snappins, S, Karisson, J. A comparison of methodologies in detection ofanaerobic thresh old. Circulation 1990; 81(Suppl II): 1138–1146.Google Scholar
13.Weymans, M, Reybrouck, T. Habitual level of physical activity and cardiorespiratory endurance capacity in children. Eur J Appl Physiol 1989; 58: 803–807.CrossRefGoogle ScholarPubMed
14.Rosenthal, M, Bush, A, Deanfleld, 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
15.Matsushita, T, Matsuda, H, Ogawa, M, Ohno, K, Sano, T, Nakano, S, Shimazaki, Y, Nakahara, K, Arisawa, J, Kozuka, T, Kawashima, Y, Yabuuchi, H. Assessment of the intrapulmonary ventilation-perfusion distribution after the Fontan procedure for complex cardiac anomalies: relation to pulmonary hemo dynamics. J Am Coll Cardiol 1990; 15: 842–848.CrossRefGoogle Scholar
16.Reybrouck, T, Rogers, R, Weymans, M, Dumoulin, M, Vanhove, M, Daenen, W, Van Der, Hauwaert L, Gewillig, M. Serial cardiorespiratory exercise testing in patients with congenital heart disease. Eur J Paed [in press]Google Scholar
17.Kopf, G, Laks, H, Stansel, H, Hellenbrand, WE, Kleinman, CS, Tamer, NS. Thirty-year follow-up of superior vena cava-pulmonary artery (Glenn) shunts. J Thorac Cardiovasc Surg 1990; 100: 662–670.CrossRefGoogle ScholarPubMed