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Similarities and differences in the exercise performance of patients after a modified Fontan procedure compared to
G Buheitel1, M Hofbeck, S Gerling
1Department of Pediatric Cardiology, University Childrens Hospital Erlangen, Germany.
Insights
Cardiopulmonary exercise performance after a Fontan procedure is quantitatively lower than after a Senning operation, with patients showing increased ventilation-perfusion mismatch. Both surgical groups exhibited responses similar to chronic heart failure patients.
Area of Science:
- Pediatric Cardiology
- Cardiopulmonary Exercise Testing
- Congenital Heart Disease
Background:
- The Fontan procedure and Senning operation are palliative surgical interventions for complex congenital heart defects.
- Assessing cardiopulmonary performance post-surgery is crucial for understanding long-term outcomes.
Purpose of the Study:
- To compare cardiopulmonary exercise performance in children following a Fontan procedure versus a Senning operation.
- To evaluate exercise responses in relation to healthy controls.
Main Methods:
- Cardiopulmonary exercise testing using a bicycle ergometer was performed on 21 children post-Fontan procedure, 13 post-Senning procedure, and 21 healthy controls.
- Mean ages were comparable across the three groups (11.1-11.2 years).
Main Results:
- Patients after Fontan procedure demonstrated the lowest peak oxygen consumption, maximal work rate, and peak oxygen pulse.
- Minute ventilation and carbon dioxide production were highest in the Fontan group, indicating increased ventilatory inefficiency.
- Patients after Fontan procedure exhibited a significantly lower carbon dioxide production per breath and increased ventilation-perfusion mismatch.
Conclusions:
- Exercise response was qualitatively similar between Fontan and Senning groups, resembling chronic heart failure patients.
- Quantitatively, Senning procedure outcomes were intermediate between Fontan and control groups.
- The Fontan group's distinct ventilation-perfusion mismatch contributed to their altered exercise response.
Objective:
To investigate cardiopulmonary performance in patients after a Fontan procedure, comparing it to patients following a Senning operation.
Methods:
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.
Results:
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 < or = 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 < or = 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.
Conclusions:
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.
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