The Fontan Choir: Singing for Single Ventricle Health and Wellbeing Feasibility Study

Children with Fontan circulation (FC) rely on passive blood flow to the lungs and require optimal lung function [1, 2]. Singing has been shown to increase exercise capacity, improve lung function and enhance quality of life (QoL) in adults and in rare studies of children with non-cardiac disease [7-9]. Singing as an intervention has not been studied in children with FC. A feasibility program of in-person and online singing and breathing instruction was developed and trialed by the Bienen School of Music and the Heart Center of the Ann & Robert H. Lurie Children's Hospital of Chicago. Pre- and post-intervention measures of exercise capacity, respiratory muscle strength, and QoL assessments were conducted before and after 8 weeks of singing instruction. This study provided 30 min of private voice instruction and 60 min of group instruction/week for eight weeks. In-person instruction was supported by an asynchronous on-line program of singing and breathing exercises performed independently several days per week between in-person sessions. The program was safe and feasible. 14 children aged 8-16 years completed the study with an 89% attendance rate and 27.5% homework completion rate. Post-intervention assessments demonstrated improvements in 3 breathing measures (single breath counting, sustained ah, and Twinkle Twinkle task) p < 0.005. Improvements occurred in patient self-report of depression (p < 0.05) and parent proxy reports of school function (p = 0.04), depression (p = 0.03) and anxiety (p = 0.02) and patient wellbeing p < 0.01. There was no improvement in spirometry or 6MWT. The program was well received by both children and parents. Our findings support the feasibility and acceptability of singing as an adjunct intervention for FC patients. Further investigation of these findings in a larger, longer trial is warranted.