This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Shachar, G. B. Articles by Lock, J. E. Search for Related Content PubMed PubMed Citation Articles by Shachar, G. B. Articles by Lock, J. E.

Circulation, Vol 65, 1043-1048, Copyright © 1982 by American Heart Association

ARTICLES

Rest and exercise hemodynamics after the Fontan procedure

GB Shachar, BP Fuhrman, Y Wang, RV Lucas Jr and JE Lock

Sixteen consecutive patients (12 with tricuspid atresia) underwent a Fontan procedure, with no operative deaths. There were three late deaths. Eleven of the survivors were electively catheterized 4-25 months postoperatively. Rest and exercise hemodynamics were measured in five patients, and resting hemodynamics alone were measured in three. All exercised patients were New York Heart Association class I Cardiac index was low at rest (2.3 +/- 0.61/min/m2) and during exercise (4.9 +/- 1.11/min/m2) due to a low stroke index both at rest (28 ml) and exercise (35 ml). Accordingly, mixed venous oxygen saturations were decreased (66% at rest and 31% during exercise). These values are significantly lower than those at rest and during exercise from 23 control patients of similar age and size. Heart rates, pulmonary vascular resistances, and left ventricular filling pressures appeared normal both at rest and during exercise. High right atrial pressure at rest (15 mm Hg) was associated with minimal conduit gradient (2 mm Hg). However, exercise increased the mean conduit gradient to 8 mm Hg, demonstrating significant functional conduit obstruction. As expected, the cardiovascular response to exercise is abnormal after the Fontan procedure, even in asymptomatic patients. This abnormal response may be exacerbated by conduit obstruction, and conduit obstruction may not be apparent during resting studies.

This article has been cited by other articles:

				K. K. Whitehead, K. Pekkan, H. D. Kitajima, S. M. Paridon, A. P. Yoganathan, and M. A. Fogel Nonlinear Power Loss During Exercise in Single-Ventricle Patients After the Fontan: Insights From Computational Fluid Dynamics Circulation, September 11, 2007; 116(11_suppl): I-165 - I-171. [Abstract] [Full Text] [PDF]

				H. Senzaki, S. Masutani, H. Ishido, M. Taketazu, T. Kobayashi, N. Sasaki, H. Asano, T. Katogi, S. Kyo, and Y. Yokote Cardiac Rest and Reserve Function in Patients With Fontan Circulation J. Am. Coll. Cardiol., June 20, 2006; 47(12): 2528 - 2535. [Abstract] [Full Text] [PDF]

				J. Rhodes, T. J. Curran, L. Camil, N. Rabideau, D. R. Fulton, N. S. Gauthier, K. Gauvreau, and K. J. Jenkins Impact of Cardiac Rehabilitation on the Exercise Function of Children With Serious Congenital Heart Disease Pediatrics, December 1, 2005; 116(6): 1339 - 1345. [Abstract] [Full Text] [PDF]

				G. Szabo, V. Buhmann, A. Graf, S. Melnitschuk, S. Bahrle, C. F. Vahl, and S. Hagl Ventricular energetics after the Fontan operation: Contractility-afterload mismatch J. Thorac. Cardiovasc. Surg., May 1, 2003; 125(5): 1061 - 1069. [Abstract] [Full Text] [PDF]

				H. Senzaki, S. Masutani, J. Kobayashi, T. Kobayashi, N. Sasaki, H. Asano, S. Kyo, Y. Yokote, and A. Ishizawa Ventricular Afterload and Ventricular Work in Fontan Circulation: Comparison With Normal Two-Ventricle Circulation and Single-Ventricle Circulation With Blalock-Taussig Shunts Circulation, June 18, 2002; 105(24): 2885 - 2892. [Abstract] [Full Text] [PDF]

				H. Ohuchi, K. Yasuda, S. Hasegawa, A. Miyazaki, M. Takamuro, O. Yamada, Y. Ono, H. Uemura, T. Yagihara, and S. Echigo Influence of ventricular morphology on aerobic exercise capacity in patients after the Fontan operation J. Am. Coll. Cardiol., June 1, 2001; 37(7): 1967 - 1974. [Abstract] [Full Text] [PDF]

				W. T. Mahle, G. Wernovsky, N. D. Bridges, A. B. Linton, and S. M. Paridon Impact of early ventricular unloading on exercise performance in preadolescents with single ventricle fontan physiology J. Am. Coll. Cardiol., November 1, 1999; 34(5): 1637 - 1643. [Abstract] [Full Text] [PDF]

				L. S. Shekerdemian, A. Bush, D. F. Shore, C. Lincoln, and A. N. Redington Cardiopulmonary Interactions After Fontan Operations : Augmentation of Cardiac Output Using Negative Pressure Ventilation Circulation, December 2, 1997; 96(11): 3934 - 3942. [Abstract] [Full Text]

				A. A. Kouatli, J. A. Garcia, T. M. Zellers, E. M. Weinstein, and L. Mahony Enalapril Does Not Enhance Exercise Capacity in Patients After Fontan Procedure Circulation, September 2, 1997; 96(5): 1507 - 1512. [Abstract] [Full Text]

				H. Uemura, T. Yagihara, Y. Kawashima, F. Yamamoto, K. Nishigaki, O. Matsuki, K. Okada, T. Kamiya, and R. H. Anderson WHAT FACTORS AFFECT VENTRICULAR PERFORMANCE AFTER A FONTAN-TYPE OPERATION? J. Thorac. Cardiovasc. Surg., August 1, 1995; 110(2): 405 - 415. [Abstract] [Full Text]

				M. Rosenthal, A. Bush, J. Deanfield, and A. Redington Comparison of Cardiopulmonary Adaptation During Exercise in Children After the Atriopulmonary and Total Cavopulmonary Connection Fontan Procedures Circulation, January 15, 1995; 91(2): 372 - 378. [Abstract] [Full Text]

				E. Magosso, S. Cavalcanti, and M. Ursino Theoretical analysis of rest and exercise hemodynamics in patients with total cavopulmonary connection Am J Physiol Heart Circ Physiol, March 1, 2002; 282(3): H1018 - H1034. [Abstract] [Full Text] [PDF]