Skip to main content Accessibility help

Similarities and differences in the exercise performance of patients after a modified Fontan procedure compared to patients with complete transposition following a Senning operation

  • Gernot Buheitel (a1), Michael Hofbeck (a1), Stephan Gerling (a1), Andreas Koch (a1) and Helmut Singer (a1)...



To investigate cardiopulmonary performance in patients after a Fontan procedure, comparing it to patients following a Senning operation.


We studied 21 children, with a mean age of 11.1 years, after a total cavopulmonary anastomosis, comparing them to 13 with complete transposition after a Senning procedure, having a mean age of 11.8 years, and 21 control subjects with a mean age of 11.2 years. All were tested on a bicycle ergospirometer.


Peak consumption of oxygen, maximal work rate, peak oxygen pulse and endexpiratory pressure of carbon dioxide at a work rate of 1.5 Watt/kg were lowest in patients with a modified Fontan procedure, and highest in the control group (p ≤ 0.0278). Production of carbon dioxide, and minute ventilation at a work rate of 1.5 Watt/kg, was highest in the patients after Fontan procedure, and lowest in the healthy subjects (p ≤ 0.0163). Production of carbon dioxide per single breath was lower in those having a Fontan procedure (28.9 ml) than in the two other groups (35.1 ml; p = 0.0243). The tidal volume showed no significant differences between the three groups.


The reaction to exercise was identical qualitatively in both groups of patients, and comparable to the behaviour of patients with chronic heart failure. Quantitatively, the results of the patients following a Senning procedure lay between those of control subjects and those who had undergone a Fontan operation. The only exception was dead space ventilation, where the patients after a Fontan procedure differed from the two other groups because of their increased ventilation-perfusion mismatch.


Corresponding author

PD Dr. G. Buheitel, Abteilung für Kinderkardiologie, Univ. Kinderklinik, Loschgestr. 15 D–91054 Erlangen, Germany. Tel: +49–9131–8533750; Fax: +49–9131–8535987


Hide All
1.Gewillig, MH, Lundström, UR, Bull, C, Wyse, RKH, Deanfield, JE. Exercise responses in patients with congenital heart disease after Fontan repair: Patterns and determinants of performance. JACC 1990; 15: 1524–1432.
2.deLeval, MR, Kilner, P, Gewillig, M, Bull, C. Total cavopulmonary connection. A logical alternative to atriopulmonary connection for complex Fontan operations.J Thorac Cardiovasc Surg 1988; 96: 682685.
3.Zellers, TM, Driscoll, DJ, Mottram, CD, Puga, FJ, Schaff, HJ, Danielson, GK. Exercise tolerance and cardiorespiratory response to exercise before and after the Fontan operation. Mayo Clin Proc 1989; 64: 14891497.
4.Rhodes, J, Garofano, PR, Bowman, FO Jr, Grant, GP, Bierman, FZ, Gersony, WM. Effect of right ventricular anatomy on the cardiopulmonary response to exercise. Implications for the Fontan procedure. Circulation 1990; 81: 18111817.
5.Nir, A, Driscoll, DJ, Mottram, CD, Offord, KP, Puga, FJ, Schaff, HV, Danielson, GK. Cardiorespiratory response to exercise after the Fontan operation: A serial study. JACC 1993; 22: 216220.
6.Gildein, P, Mocellin, R, Kaufmehl, K. Oxygen uptake transient kinetics during constant-load exercise in children after opera tions of ventricular septal defect, tetralogy of Fallot, transpo sition of the great arteries, or tricuspid valve atresia. Am J Cardiol 1994; 74: 166169.
7.Harrison, DA, Liu, P, Walters, JE, Goodman, JM, Siu, SC, Webb, GD, Williams, WG, McLaughlin, PR. Cardiopulmonary function in adult patients late after Fontan repair. JACC 1995; 26: 10161021.
8.Troutman, WB, Barstow, TJ, Galindo, AJ, Cooper, DM. Abnormal dynamic cardiorespiratory responses to exercise in pediatric patients after Fontan procedure. JACC 1998; 31: 668673.
9.Driscoll, DJ, Durongpisitkul, K. Exercise testing after the Fontan operation. Pediatr Cardiol 1999; 20: 5759.
10.Paul, MH, Wessel, HU. Exercise studies in patients with trans position of the great arteries after atrial repair operations (Mustard/Senning): A review. Pediatr Cardiol 1999; 20: 4955.
11.Del Torso, S, Kelly, MJ, Kalff, V, Venables, AW. Radionuclide assessment of ventricular contraction at rest and during exercise following the Fontan procedure for either tricuspid atresia or single ventricle. Am J Cardiol 1985; 55: 11271132.
12.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 func tional single ventricle. JACC 1986; 7: 10871094.
13.Cortes, RGS, Satomi, G, Yoshigi, M, Momma, K. Maximal hemodynamic response after the Fontan procedure: Doppler evaluation during the treadmill test. Pediatr Cardiol 1994; 15: 170177.
14.Weber, KT, Janicki, JS. Cardiopulmonary exercise testing for evaluation of chronic cardiac failure. Am J Cardiol 1985; 55:22A31A.
15.Mocellin, R. Exercise testing in children with congenital heart disease. Pediatrician 1986; 13: 1825.
16.Rosenthal, M, Bush, A, Deanfiel, dJ, Redington, A. Comparison of cardiopulmonary adaptation during exercise in children after the atriopulmonary and total cavopulmonary connection Fontan procedures. Circulation 1995; 91:372378.
17.Braden, DS, Carroll, JF. Normative cardiovascular responses to exercise in children. Pediatr Cardiol 1999; 20: 410.
18.Wasserman, K. Determinants and detection of anaerobic threshold and consequences of exercise above it. Circulationy 1987; 76(Suppl 6): VI–29VI–38.
19.Reybrouck, T, Rogers, R, Weymans, M, Dumoulin, M, Vanhove, M, VanderHauwaert, L, Gewilling, M. Serial cardiorespiratory exercise testing in patients with congenital heart disease. Eur J Pedatr 1995; 154:801806.
20.Mertens, L, Rogers, R, Reybrouck, T, Dumoulin, M, Vanhees, L, Gewillig, M. Cardiopulmonary response to exercise after the Fontan operation-a cross-sectional and longitudinal evalu ation. Cardiol Young 1996; 6: 136142.
21.Reybrouck, T, Mertens, L, Kalis, N, Weymans, M, Dumoulin, M, Daenen, W, Gewillig, M. Dynamics of respiratory gas exchange during exercise after correction of congenital heart disease. J Appi Physiol 1996; 80: 458463.
22.Wasserman, K, Hansen, JE, Sue, DY, Whipp, BJ, Casaburi, R. Principles of exercise testing and interpretation. Williams and Wilkins, Philadelphia, Baltimore, Hong Kong, London, Munich, Sydney, Tokyo, 1994.
23.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.JACC 1990; 15: 842848.


Similarities and differences in the exercise performance of patients after a modified Fontan procedure compared to patients with complete transposition following a Senning operation

  • Gernot Buheitel (a1), Michael Hofbeck (a1), Stephan Gerling (a1), Andreas Koch (a1) and Helmut Singer (a1)...


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed