Impact of exercise training on muscle function and ergoreflex in Fontan patients: A pilot study

Exercise capacity and impact of exercise training in patients after a Fontan procedure: A review

“…The blood pressure response to exercise seems normal and adapted to the workload (14,15). However, a higher diastolic blood pressure response during exercise has also been reported (11), and may be explained by the absence of a systemic-to-pulmonary shunt (11) and/or may be linked to the abnormal reflex signals coming from the ergoreceptors (15). A lower peak systolic blood pressure, probably due to a lower Q, has also been documented (35).…”

“…The main studies supporting these observations are reviewed, with a focus on the physiological adaptation and limitation of the exercise performance as well as the benefits of exercise training in patients after a Fontan procedure. (14,15). Nevertheless, the long-term impact of this procedure on exercise tolerance is equivocal.…”

“…This leads to a limited increase in pulmonary blood flow in response to exercise, a reduced left ventricle filling and a smaller stroke volume, resulting in a reduced increase in Q. The blood pressure response to exercise seems normal and adapted to the workload (14,15). However, a higher diastolic blood pressure response during exercise has also been reported (11), and may be explained by the absence of a systemic-to-pulmonary shunt (11) and/or may be linked to the abnormal reflex signals coming from the ergoreceptors (15).…”

“…This is demonstrated by an elevated ventilatory equivalent for oxygen at rest and at (41) No change in submaximal heart rate Driscoll et al (41) Higher or no change in blood Driscoll et al (10) (10) ventilation maximal exercise (14). Following the surgical procedure, the ventilatory equivalent for oxygen may be corrected at rest but stays slightly elevated at maximal exercise (15,37). This is the consequence of an increased physiological dead space to tidal volume ratio resulting from ventilation or perfusion mismatch and a persistent right-to-left shunt, hypoxic stimulation of ventilation and/or the need to maintain acid-base homeostasis by eliminating carbon dioxide from a reduced blood volume (10,14,39,41).…”

“…This is the consequence of an increased physiological dead space to tidal volume ratio resulting from ventilation or perfusion mismatch and a persistent right-to-left shunt, hypoxic stimulation of ventilation and/or the need to maintain acid-base homeostasis by eliminating carbon dioxide from a reduced blood volume (10,14,39,41). Furthermore, a significant increment of the ventilatory equivalent for carbon dioxide has also been reported (15,37,(42)(43)(44), suggesting excessive ventilation in patients after a Fontan procedure compared with healthy individuals. These abnormalities may be secondary to the increased physiological dead space to tidal volume ratio or a lower chemoreceptors threshold for arterial carbon dioxide partial pressure (42).…”