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Cardiorespiratory response to exercise after modified Fontan operation: determinants of performance
K Durongpisitkul1, D J Driscoll, D W Mahoney
1Section of Pediatric Cardiology, Rochester, Minnesota 55905, USA.
Journal of the American College of Cardiology
|March 15, 1997
Summary
Exercise capacity after the modified Fontan operation is often reduced. Key factors influencing exercise performance include age, gender, body size, and specific surgical details like the Glenn anastomosis.
Area of Science:
- Cardiovascular Physiology
- Pediatric Cardiology
- Surgical Outcomes
Background:
- The Fontan operation is a palliative procedure for complex single-ventricle congenital heart defects.
- Previous studies indicate reduced cardiorespiratory fitness post-Fontan, but determinants are unclear.
Purpose of the Study:
- To quantify cardiorespiratory responses during exercise in Fontan patients.
- To identify perioperative factors affecting exercise performance in this population.
Main Methods:
- Retrospective analysis of 59 patients undergoing modified Fontan operation.
- Resting spirometry and incremental cycle ergometry with physiological measurements.
- Multivariate regression to identify associations with peak oxygen uptake (VO2max), oxygen saturation (O2sat), and heart rate (HRmax).
Main Results:
- VO2max, O2sat, and HRmax varied significantly, often below normal ranges.
- Age, gender, body surface area, and preoperative pulmonary artery status influenced VO2max.
- Preoperative factors and the presence of a Glenn anastomosis affected O2sat.
- Age, body surface area, resting heart rate, and blood pressure correlated with HRmax.
Conclusions:
- Subnormal exercise capacity (VO2max, HRmax) is common after the modified Fontan operation.
- Perioperative variables significantly impact exercise performance, particularly VO2max and O2sat.
- The classic Glenn anastomosis may contribute to reduced oxygen saturation due to intrapulmonary shunting.