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CLINICAL STUDY: PEDIATRIC CARDIOLOGY

Influence of ventricular morphology on aerobic exercise capacity in patients after the Fontan operation

Hideo Ohuchi, MD^*, Kenji Yasuda, MD^*, Satoshi Hasegawa, MD^*, Aya Miyazaki, MD^*, Motoki Takamuro, MD^*, Osamu Yamada, MD^*, Yasuo Ono, MD^*, Hideki Uemura, MD, Toshikatsu Yagihara, MD and Shigeyuki Echigo, MD^*

^* Department of Pediatrics, National Cardiovascular Center, Osaka, Japan
Department of Thoracic Surgery, National Cardiovascular Center, Osaka, Japan

Manuscript received October 23, 2000; revised manuscript received February 12, 2001, accepted February 26, 2001.

Reprint requests and correspondence: Dr. Hideo Ohuchi, Department of Pediatrics, National Cardiovascular Center, Fujishiro-dai, Suita, Osaka 565-8565, Japan

OBJECTIVES

This study investigated the influences of ventricular morphology, hemodynamics and clinical findings on exercise capacity in patients after the Fontan operation.

BACKGROUND

Determinants of exercise capacity after the Fontan operation remain unclear.

METHODS

Peak oxygen uptake (PO₂) was determined in 105 patients by exercise test and compared to hemodynamics and clinical findings. Patients were divided into three groups based on ventricular morphology: those with a right ventricle (group RV), a biventricle (group BV) and a left ventricle (group LV).

RESULTS

Ten patients with atrioventricular valve regurgitation (AVVR) or hypoxia exhibited a low PO₂. After excluding these patients, although PO₂ did not correlate with hemodynamics, except ventricular ejection fraction (p < 0.02), it correlated with age at the Fontan operation and exercise test (p < 0.002). The PO₂ was higher in group LV (63 ± 9%) than in groups RV (55 ± 9%) and BV (55 ± 12%) (p < 0.01), while an inverse correlation between PO₂ and age at operation was demonstrated only in group RV (p < 0.05). Groups RV or BV and age at exercise test were associated with a lower PO₂, whereas group LV was an independent predictor of a higher PO₂ (p < 0.01). During 4.2 years of follow-up, a decrease in peak heart rate was related to a decrease in PO₂ (p < 0.05). The PO₂ decreased in group RV (p < 0.01).

CONCLUSIONS

In addition to AVVR, hypoxia, and heart rate response, ventricular morphology is related to exercise capacity. Early Fontan operation may be beneficial in terms of exercise capacity, especially in the group RV patients.

Abbreviations and Acronyms   AVVR = atrioventricular valve regurgitation   EDP = end-diastolic pressure of the systemic ventricle   EDVI = end-diastolic ventricular volume index   EF = systemic ventricular ejection fraction   PO2 = predicted peak oxygen uptake   Rp = pulmonary artery resistance   Rs = systemic artery resistance   VC = predicted vital capacity   E/CO2 = ventilatory equivalent for carbon dioxide production   O2 = oxygen uptake

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