Exercise Capacity Impaired in Survivors of Heart Procedure

July 2, 2008

Survivors of the Fontan procedure, performed to correct anomalies in a functional single ventricle, still have deficits in exercise capacity but generally are doing well, according to three studies published in the July 8 issue of the Journal of the American College of Cardiology.

WEDNESDAY, July 2 (HealthDay News) -- Survivors of the Fontan procedure, performed to correct anomalies in a functional single ventricle, still have deficits in exercise capacity but generally are doing well, according to three studies published in the July 8 issue of the Journal of the American College of Cardiology.

In the first study, Stephen M. Paridon, M.D., from the Children's Hospital of Philadelphia, and colleagues examined exercise performance in 411 Fontan survivors (median age 12.4 years) by ramp cycle ergometry with expired gas. They found that only 166 achieved a maximal aerobic capacity, and peak oxygen consumption was only 65 percent of that predicted for their age and gender. Performance was higher for those with a high oxygen pulse, and lower for males and adolescents.

In the second study, Jeffery Meadows, M.D., and colleagues from Children's Hospital-Boston performed exercise testing pre- and post-fenestration closure in 20 patients (median age 10 years) undergoing the Fontan procedure. They found that peak oxygen consumption was reduced and the ventilatory response to exercise was abnormal before surgery. After surgery, there was no improvement in peak oxygen consumption, although there was a significant improvement in ventilatory abnormalities.

In the third study, Page A.W. Anderson, M.D., from Duke University Medical Center in Durham, N.C., and colleagues investigated the characteristics of 546 Fontan survivors (mean age 11.9 years). They found that half of cases involved the left ventricle, 73 percent had a normal ejection fraction, 28 percent had a normal diastolic function grade, more than 80 percent were in the normal range on a child health questionnaire, and mean percent predicted peak oxygen consumption was 65 percent and fell with age. The 34 percent of patients with right ventricular morphology had poorer function.

"The Fontan operation truly has come a very long way in the 40 years since the first procedure for tricuspid atresia performed by Fontan in 1968," Carl L. Backer, M.D., from Children's Memorial Hospital in Chicago, writes in an accompanying editorial. "Intensive investigations in this issue of the Journal have demonstrated that although these patients do remarkably well, they do not keep up with age-matched control subjects in exercise ability."

Abstract - ParidonFull Text (subscription or payment may be required)Abstract - MeadowsFull Text (subscription or payment may be required)Abstract - AndersonFull Text (subscription or payment may be required)Editorial

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