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Exercise capacity reflects ventricular function in patients having the Fontan circulation

Published online by Cambridge University Press:  01 August 2009

Katrin Klimes ,
Stanislav Ovroutski ,
Hashim Abdul-Khaliq ,
Peter Ewert ,
Vladimir Alexi-Meskishvili ,
Titus Kuehne ,
Matthias Gutberlet  and
Felix Berger
Katrin Klimes*
Affiliation:
Departments of 1Congenital Heart Defects/Pediatric Cardiology, Deutsches Herzzentrum Berlin,
Stanislav Ovroutski
Affiliation:
Departments of 1Congenital Heart Defects/Pediatric Cardiology, Deutsches Herzzentrum Berlin,
Hashim Abdul-Khaliq
Affiliation:
Pediatric Cardiology, Universität des Saarlandes,
Peter Ewert
Affiliation:
Departments of 1Congenital Heart Defects/Pediatric Cardiology, Deutsches Herzzentrum Berlin,
Vladimir Alexi-Meskishvili
Affiliation:
Thoracic and Cardiovascular Surgery, Deutsches Herzzentrum Berlin, and
Titus Kuehne
Affiliation:
Departments of 1Congenital Heart Defects/Pediatric Cardiology, Deutsches Herzzentrum Berlin,
Matthias Gutberlet
Affiliation:
Diagnostic and Interventional Radiology, Herzzentrum Leipzig, Germany
Felix Berger
Affiliation:
Departments of 1Congenital Heart Defects/Pediatric Cardiology, Deutsches Herzzentrum Berlin,
*
Correspondence to: Katrin Klimes, MD, Department of Congenital Heart Defects/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353 Berlin, Germany. Tel: +49-30-4593-2800; Fax: +49-30-4593-2900; E-mail: klimes@dhzb.de
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Abstract

Background

In this study we sought to determine, first, whether maximal exercise capacity reflects ventricular function, and second, whether the age of the patient, and the age of completion of the Fontan circulation, influence ventricular function and exercise performance.

Methods and Results

Cardiac magnetic resonance imaging and cardiopulmonary exercise testing were performed in 29 patients at a median time of 6.9 years after completion of the Fontan circulation. We divided the patients into 2 groups, the first 19 having their operation below the age of 18 years, and the second group, of 10 patients, having completion of the Fontan circulation when they were older than 18 years. Parameters for ventricular function and exercise were compared for both groups with controls.

Compared to controls, the younger patients had normal end-diastolic ventricular volumes, but significantly impaired ventricular function, lower maximal work load and consumption of oxygen. The older patients had greater end-diastolic ventricular volumes, and significantly poorer ventricular function than both the younger patients and the controls. Maximal work load and consumption of oxygen were significantly lower in the older patients than in the younger ones and the controls.

Conclusion

Patients with the Fontan circulation have an impaired systolic ventricular function, which correlates with maximal exercise capacity and uptake of oxygen. Those having completion of the Fontan circulation when younger than 18 years had significantly better ventricular function and exercise performance than those who had completion of the Fontan circulation at an older age. An early creation of the Fontan circulation may preserve cardiac function and exercise capacity.

Keywords

Functionally univentricular heartcavopulmonary connectioncongenital heart disease
Type
Original Articles
Information
Cardiology in the Young , Volume 19 , Issue 4 , August 2009 , pp. 340 - 345
Copyright
Copyright © Cambridge University Press 2009

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