Oxygen Utilization and Hemodynamic Response during Exercise in Children after Fontan Procedure.

Abstract

SUMMARYEight patients, 9.1 to 16.5 years of age, were studied 2.8 to 8.5 years after Fontan operation. Oxygen utilization was determined during upright bicycle exercise. The cardiac index and stroke index were measured by echocardiography and the anaerobic threshold was determined. The results were compared with 10 patients after surgical closure of the atrial septal defect. Anaerobic threshold (AT) in Fontan patients was lower than in the control subjects. Oxygen consumption at each stage of exercise was significantly lower in the Fontan group compared with the control subjects. From the beginning of exercise until AT, the increase in stroke index was lower in the Fontan patients than in the control subjects. After that point, the stroke index decreased significantly in the Fontan patients while it remained almost at the same level in the control subjects. Significant correlations were observed between the oxygen pulses and the stroke index at AT both in the control and Fontan groups. These results suggest that impaired exercise capacity in Fontan patients is mainly due to a subnormal response of the stroke index at AT and to the decreased response of the stroke index and the heart rate at the maximal workload. (Jpn Heart J 1998; 39: 659-669)

Physical activity levels in children and adolescents are reduced after the Fontan procedure, independent of exercise capacity, and are associated with lower perceived general health

“…[3][4][5][6][7][8][9] While the maximal exercise capacity of children with congenital heart disease has been studied, 10 little is known about the levels of habitual physical activity, especially after the Fontan procedure. [11][12][13] Only one study 12 objectively quantified habitual physical activity levels by accelerometry, and another case study used a heart rate monitor.…”

Exercise Capacity and Training Programs in Paediatric Fontan Patients: A Systematic Review

“…17 Two studies reported significantly decreased submaximal heart rate response, 28,31 and it was suggested by Banks et al 28 that paediatric Fontan patients may experience enhanced submaximal exercise efficiency relative to healthy individuals. Miyairi et al 23 reported that the heart rate response is similar to controls until patients reach the anaerobic threshold and significantly lower at the peak work load. Two studies examined Fontan aortic haemodynamics and found increased pulse wave velocity 26 or ratio in the backward-to-forward compression waves, 32 suggesting greater VO 2 at (V)AT (% predicted) 67 AE 14 72 -96 AE 25 25 25,27,44,68,70,72,73 The table excludes studies that reported these parameters as medians and interquartile ranges, rather than as means.…”

“…Reported mean VO 2peak values ranged from 14.4 AE 6.1 mL/kg/min 17 to 35.97 AE 6.84 mL/kg/min, 18 and mean percent-predicted VO 2peak values ranged from 54.3% AE 9.2% 19 to 86% AE 19% 20 (Table 1). Multiple studies reported significantly lower VO 2peak , 17,18,[21][22][23][24] VO 2 at anaerobic threshold, 17,23,25 and O 2 pulse 17,21 relative to healthy individuals. Although reductions in both maximal and submaximal exercise capacity have been reported, 26 submaximal exercise parameters are typically less reduced than those for maximal exercise.…”

“…Reported values for the mean peak heart rate ranged from 142.2 AE 24.8 bpm 17 to 173.5 AE 16.0 bpm 26 (Table 1). Multiple studies reported that, compared with healthy controls, paediatric Fontan patients demonstrated significantly diminished peak stroke volume, 26 peak heart rate, 17,18,21,24,28 maximal heart rate, 23,29,30 heart rate gradient, 17 maximal heart rate response, 28,31 maximal stroke index, 23 stroke index response, 23 O 2 pulse, 30 and exercising O 2 saturation. 17 Two studies reported significantly decreased submaximal heart rate response, 28,31 and it was suggested by Banks et al 28 that paediatric Fontan patients may experience enhanced submaximal exercise efficiency relative to healthy individuals.…”

Current Outcomes and Considerations in Hypoplastic Left Heart Syndrome

“…Growth retardation, decreased exercise tolerance, and reduced activity levels are common is survivors of both palliative surgery [54][55][56] and transplantation [56][57][58][59][60][61]. Children who undergo either surgical option are at substantial risk of pain and anxiety related to procedures, and children often require frequent and prolonged hospital admissions for complications and for post-transplant cardiac biopsies.…”