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Clinical Significance of Central Venous Pressure During Exercise After Fontan Procedure

Seiji Asagai1, Kei Inai2,3, Eriko Shimada1

  • 1Department of Pediatric Cardiology and Adult Congenital Cardiology, Tokyo Women's Medical University, Tokyo, Japan.

Pediatric Cardiology
|November 13, 2019
PubMed

Insights

Elevated central venous pressure (CVP) during exercise in Fontan procedure patients may indicate higher risk for late complications. Measuring CVP during exertion is crucial for predicting long-term risks in these individuals.

Area of Science:

  • Cardiology
  • Pediatric Cardiology
  • Congenital Heart Disease

Background:

  • The Fontan procedure is a palliative surgery for complex congenital heart defects.
  • Late complications are common in Fontan survivors, with elevated central venous pressure (CVP) being a known factor.
  • The relationship between CVP, both at rest and during exercise, and the development of late complications remains unclear.

Purpose of the Study:

  • To investigate the association between central venous pressure (CVP) during rest and exercise and the incidence of late complications in patients who have undergone the Fontan procedure.
  • To determine if CVP measurements during exercise can serve as a predictor for long-term adverse outcomes in Fontan survivors.

Main Methods:

  • A cohort of 34 patients who underwent the Fontan procedure was studied, with a median age of 19.3 years and median follow-up of 12.7 years.
  • Central venous pressure (CVP) and cardiac index were measured at rest and during exercise.
  • Laboratory markers including brain natriuretic peptide, gamma-glutamyl transpeptidase, type IV collagen 7S, and creatinine were analyzed and compared between high-CVP and low-CVP groups during exercise.

Main Results:

  • During exercise, CVP increased significantly from a median of 11 to 19 mmHg, and cardiac index increased from 2.1 to 4.4 L/min/m².
  • In 38% of patients, CVP differed between resting and exercise conditions.
  • The high-CVP group during exercise showed significantly elevated levels of brain natriuretic peptide, gamma-glutamyl transpeptidase, type IV collagen 7S, and creatinine compared to the low-CVP group.

Conclusions:

  • Elevated central venous pressure (CVP) during exercise is potentially associated with increased risk of long-term complications following the Fontan procedure.
  • Measuring CVP during exercise is recommended for Fontan survivors to better assess and predict the risk of developing late complications.
  • This approach may aid in personalized risk stratification and management strategies for Fontan patients.

Keywords:
Central venous pressureExerciseFontan procedureLong-term complication

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