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Original Articles: Cardiovascular

Invited Commentary

Department of Cardiology, Children’s Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201

(Email: rross{at}dmc.org).

Giardini and colleagues [1] assessed exercise capacity over time in patients who have undergone one of the variations of the Fontan procedure for single-ventricle physiology. The strength of this article is the length of follow-up of these patients, with an average of a 9-year interval between the first and last exercise tests. The results confirm the impression from previous cross-sectional studies that exercise performance is reduced after the Fontan operation and there is a progressive further decline in exercise capacity over time. This was more pronounced in those with morphologic single right ventricles compared with left ventricles and in those who underwent an atriopulmonary or atrioventricular connection compared with the total cavopulmonary connection.

We are now in an era where excellent surgical survival has changed our patient demographics such that adults with congenital heart disease equal or outnumber children with these lesions. This means that longitudinal studies such as this one will be more and more possible. Although retrospective in design, the data are useful to guide our approach to monitoring these patients and helping with the difficult decisions about when to intervene with conversion to a total cavopulmonary connection or listing for cardiac transplantation. Future work could include evaluation of specific exercise indicators that might be useful to predict the need for surgery or listing for transplantation in the same way that low maximal oxygen consumption may lead to listing patients with dilated cardiomyopathy.

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1. Giardini A, Hager A, Napoleone CP, Picchio FM. Natural history of exercise capacity after the Fontan operation: a longitudinal study Ann Thorac Surg 2008;85:818-822.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Ross, R. D. Search for Related Content PubMed PubMed Citation Articles by Ross, R. D. Related Collections Congenital - cyanotic Related Article