| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
a Pediatric Cardiology and Adult Congenital Unit, University of Bologna, Bologna, Italy
b Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München, Technische Universität, Munich, Germany
Accepted for publication November 2, 2007.
* Address correspondence to Dr Giardini, Pediatric Cardiology and Adult Congenital Unit, University of Bologna, Via Massarenti 9, Bologna, 40138, Italy (Email: alessandro5574{at}iol.it).
Background: Previous studies have shown that older Fontan patients and those with an underlying morphologically right ventricle have lower exercise capacity. We sought to assess the natural history of exercise capacity after the Fontan operation in individual patients, and to identify the factors influencing the rate of decrease of exercise capacity over time.
Methods: We studied, longitudinally, 53 Fontan patients with cardiopulmonary exercise tests (average 3.2 ± 1.1 tests for each patient). Age at the first test was 14 ± 6 years. Time intervals between tests ranged from 1 to 16 years (average, 7.7 ± 4.0 years). The morphology of the functionally single ventricle was left in 29 patients (55%) and right in 24 patients (45%). Twenty-two patients had undergone a total cavopulmonary connection (TCPC) at a mean age of 5.9 ± 2.8 years. Thirty-one patients had undergone an atriopulmonary or an atrioventricular connection at an age of 6.9 ± 4.4 years. Exercise capacity was expressed as percentage of predicted peak oxygen uptake (VO 2).
Results: Overall, peak VO 2 decreased at a rate of –2.6 ± 2.7%/year. Ventricular morphology (r = 0.525, p = 0.0001) and type of Fontan operation (r = 0.381, p = 0.0057) appeared as the only predictors of the rate of decrease of peak VO 2 at multivariate analysis. Patients with an underlying left ventricular morphology (–1.7 ± 2.0 vs –3.7 ± 3.2%/year, p = 0.005), and those who underwent a TCPC (–1.9 ± 1.8 vs –3.3 ± 3.2%/year, p = 0.042), had the lowest rate of decrease in peak VO 2.
Conclusions: Exercise capacity progressively declines in Fontan subjects. The decline of exercise capacity seems to be slower in patients with an underlying left ventricular morphology and in those who received a TCPC.
Related Article
Ann. Thorac. Surg. 2008 85: 821-822.
This article has been cited by other articles:
|
|
 |
|
  A. Kempny, K. Dimopoulos, A. Uebing, P. Moceri, L. Swan, M. A. Gatzoulis, and G.-P. Diller Reference values for exercise limitations among adults with congenital heart disease. Relation to activities of daily life--single centre experience and review of published data Eur. Heart J., December 23, 2011; (2011) ehr461v1. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. J. Goldberg, B. French, M. G. McBride, B. S. Marino, N. Mirarchi, B. D. Hanna, G. Wernovsky, S. M. Paridon, and J. Rychik Impact of Oral Sildenafil on Exercise Performance in Children and Young Adults After the Fontan Operation: A Randomized, Double-Blind, Placebo-Controlled, Crossover Trial Circulation, March 22, 2011; 123(11): 1185 - 1193. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Pace Napoleone, A. Giardini, and G. Gargiulo Reply to d'Udekem et al. Eur J Cardiothorac Surg, January 1, 2011; 39(1): 144 - 145. [Full Text] [PDF]
|
|
|
|
|
|
G.-P. Diller, A. Giardini, K. Dimopoulos, G. Gargiulo, J. Muller, G. Derrick, G. Giannakoulas, S. Khambadkone, A. E. Lammers, F. M. Picchio, et al. Predictors of morbidity and mortality in contemporary Fontan patients: results from a multicenter study including cardiopulmonary exercise testing in 321 patients Eur. Heart J., December 2, 2010; 31(24): 3073 - 3083. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Endorsed by the Association for European Paediatri, Authors/Task Force Members, H. Baumgartner, P. Bonhoeffer, N. M. S. De Groot, F. de Haan, J. E. Deanfield, N. Galie, M. A. Gatzoulis, C. Gohlke-Baerwolf, et al. ESC Guidelines for the management of grown-up congenital heart disease (new version 2010): The Task Force on the Management of Grown-up Congenital Heart Disease of the European Society of Cardiology (ESC) Eur. Heart J., December 1, 2010; 31(23): 2915 - 2957. [Full Text] [PDF]
|
|
|
|
 |
|
 M. Beghetti Fontan and the pulmonary circulation: a potential role for new pulmonary hypertension therapies Heart, June 1, 2010; 96(12): 911 - 916. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Pace Napoleone, G. Oppido, E. Angeli, A. Giardini, E. Resciniti, and G. Gargiulo Results of the modified Fontan procedure are not related to age at operation Eur J Cardiothorac Surg, March 1, 2010; 37(3): 645 - 650. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Giardini and A. Hager The Effect of Age at Fontan Completion on Long-Term Aerobic Exercise Capacity in Fontan Patients Ann. Thorac. Surg., February 1, 2010; 89(2): 675 - 676. [Full Text] [PDF]
|
|
|
|
|
|
J. Muller, F. Christov, C. Schreiber, J. Hess, and A. Hager Exercise capacity, quality of life, and daily activity in the long-term follow-up of patients with univentricular heart and total cavopulmonary connection Eur. Heart J., December 1, 2009; 30(23): 2915 - 2920. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. E. Deanfield, R. Yates, F. J. Meijboom, and B. J.M. Mulder CHAPTER 10 Congenital Heart Disease in Children and Adults ESC Textbook of Cardiovascular Medicine, January 1, 2009; 2(1): med-9780199566990-chapter - med-9780199566990-chapter. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. P. Graham Jr The Year in Congenital Heart Disease J. Am. Coll. Cardiol., October 28, 2008; 52(18): 1492 - 1499. [Full Text] [PDF]
|
|
|
|
|
|
R. D. Ross Invited Commentary Ann. Thorac. Surg., March 1, 2008; 85(3): 821 - 822. [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
