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  • Title: Post-exercise heart rate, blood pressure and oxygen uptake dynamics in pediatric patients with Fontan circulation Comparison with patients after right ventricular outflow tract reconstruction.
    Author: Ohuchi H, Hamamichi Y, Hayashi T, Watanabe T, Yamada O, Yagihara T, Echigo S.
    Journal: Int J Cardiol; 2005 May 11; 101(1):129-36. PubMed ID: 15860395.
    Abstract:
    BACKGROUND: Post-exercise heart rate (HR) and oxygen uptake (V O(2)) recover more slowly in patients with the Fontan circulation, but little is known about the determinants of the delayed recovery. PURPOSE: To evaluate the post-exercise cardiovascular dynamics and clinical profiles in these patients. METHODS AND RESULTS: We studied 51 Fontan patients (14+/-4 years) (atriopulmonary connection, APC = 18 and total cavopulmonary connection, TCPC = 33) and compared the results with 34 patients after right ventricular outflow tract reconstruction (RVOTR) with identical exercise capacity and arterial baroreflex sensitivity (BRS) (15+/-4 years) and with 26 controls (14+/-4 years). There were no differences in post-exercise HR or VO2 declines between the Fontan and RVOTR groups. Although the systolic blood pressure (SBP) decline was delayed in the RVOTR group (p < 0.01), its early decline in the Fontan group was rapid and equivalent to that in controls. In Fontan patients, BRS had a great impact on early HR decline (p < 0.05) and early VO2 decline was determined by peak VO2, age and cardiac index (p < 0.05-0.001). TCPC and lower BRS were the main determinants of the slower SBP decline (p < 0.05). In another study of repeated paired exercise tests before and after Fontan operation, post-exercise SBP decline became greater after the operation (p < 0.07). CONCLUSIONS: In the Fontan group, post-exercise HR and VO2 declines are markedly delayed and are determined by cardiac vagal nervous activity, exercise capacity and age, respectively. Despite identical impaired hemodynamics and exercise capacity, post-exercise SBP decline is greater in the Fontan group, especially after APC, than in the RVOTR patients.
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