Hostname: page-component-78c5997874-mlc7c Total loading time: 0 Render date: 2024-11-16T09:20:22.820Z Has data issue: false hasContentIssue false
  • English
  • Français

Correlation of exercise-induced peripheral venous hypertension with exercise intolerance in patients with Fontan circulation

Published online by Cambridge University Press:  22 October 2021

Shin Ono Open the ORCID record for Shin Ono [Opens in a new window] ,
Sadamitsu Yanagi ,
Takuya Wakamiya ,
Yasuhiro Ichikawa Open the ORCID record for Yasuhiro Ichikawa [Opens in a new window] ,
Shun Kawai ,
Ki-Sung Kim  and
Hideaki Ueda
Shin Ono*
Affiliation:
Department of Pediatric Cardiology, Kanagawa Children’s Medical Center, Yokohama, Japan
Sadamitsu Yanagi
Affiliation:
Department of Pediatric Cardiology, Kanagawa Children’s Medical Center, Yokohama, Japan
Takuya Wakamiya
Affiliation:
Department of Pediatric Cardiology, Kanagawa Children’s Medical Center, Yokohama, Japan
Yasuhiro Ichikawa
Affiliation:
Department of Pediatric Cardiology, Kanagawa Children’s Medical Center, Yokohama, Japan
Shun Kawai
Affiliation:
Department of Pediatric Cardiology, Kanagawa Children’s Medical Center, Yokohama, Japan
Ki-Sung Kim
Affiliation:
Department of Pediatric Cardiology, Kanagawa Children’s Medical Center, Yokohama, Japan
Hideaki Ueda
Affiliation:
Department of Pediatric Cardiology, Kanagawa Children’s Medical Center, Yokohama, Japan
*
Author for correspondence: Dr S. Ono, Department of Pediatric Cardiology, Kanagawa Children’s Medical Center, 2-138-4 Mutsukawa, Minami-ku, Yokohama, Kanagawa 232-8555, Japan. Tel: +81-45-711-2351; Fax: +81-45-721-3324. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Owing to the absence of a sub-pulmonary ventricle, the central venous pressure rises in patients with Fontan circulation. During exercise, central venous pressure may rise further to increase the systemic ventricular preload and cardiac output. We performed a single-centre prospective trial of cardiopulmonary exercise test while monitoring peripheral venous pressure which strongly correlates with central venous pressure. The objective of this study was to test the hypothesis that peripheral venous pressure at peak exercise inversely correlates with exercise capacity in patients with Fontan circulation. Seventeen patients following Fontan operation performed cardiopulmonary exercise test while monitoring peripheral venous pressure. Peak oxygen uptake, heart rate reserve, peak oxygen pulse (divided by body surface area), and peripheral venous pressure at peak exercise were measured. Correlations of peripheral venous pressure at peak exercise with the peak oxygen uptake, heart rate reserve, and peak oxygen pulse were evaluated. The peripheral venous pressure at peak exercise inversely correlated with the peak oxygen uptake (R = −0.66, p < 0.01), heart rate reserve (R = −0.6, p < 0.05), and peak oxygen pulse (R = −0.48, p < 0.05). Exercise-induced peripheral venous hypertension correlates with exercise intolerance in patients with Fontan circulation. Peak oxygen uptake is a useful index for evaluating the status of congestion in the daily life of patients with Fontan circulation.

Keywords

Fontanvenous pressureexercise intolerancecardiopulmonary exercise test
Type
Original Article
Information
Cardiology in the Young , Volume 32 , Issue 9 , September 2022 , pp. 1427 - 1431
Check for updates
Copyright
© The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Fontan, F, Baudet, E. Surgical repair of tricuspid atresia. Thorax 1971; 26: 240–248.CrossRefGoogle ScholarPubMed
Hosein, RB, Clarke, AJ, McGuirk, SP, et al. Factors influencing early and late outcome following the Fontan procedure in the current era. The ‘Two Commandments’? Eur J Cardiothorac Surg 2017; 31: 344–352.CrossRefGoogle Scholar
Ohuchi, H. Adult patients with Fontan circulation: What we know and how to manage adults with Fontan circulation? J Cardiol 2016; 68: 181–189.CrossRefGoogle ScholarPubMed
Gewillig, M, Brown, SC. The Fontan circulation after 45 years: update in physiology. Heart 2016; 102: 1081–1086.CrossRefGoogle ScholarPubMed
Ohuchi, H, Negishi, J, Noritake, K, et al. Prognostic value of exercise variables in 335 patients after the Fontan operation: a 23-year single-center experience of cardiopulmonary exercise testing. Congenit Heart Dis 2015; 10: 105–116.CrossRefGoogle ScholarPubMed
Milhoan, KA, Levy, DJ, Shields, N, et al. Upper extremity peripheral venous pressure measurements accurately reflect pulmonary artery pressures in patients with cavopulmonary or Fontan connections. Pediatr Cardiol 2004; 25: 17–19.CrossRefGoogle ScholarPubMed
Masutani, S, Kurishima, C, Yana, A, et al. Assessment of central venous physiology of Fontan circulation using peripheral venous pressure. J Thorac Cardiovasc Surg 2017; 153: 912–920.CrossRefGoogle ScholarPubMed
Navaratnam, D, Fitzsimmons, S, Grocott, M, et al. Exercise-induced systemic venous hypertension in the Fontan circulation. Am J Cardiol 2016; 117: 1667–1671.CrossRefGoogle ScholarPubMed
Ohuchi, H, Nakajima, T, Kawade, M, et al. Measurement and validity of the ventilatory threshold in patients with congenital heart disease. Pediatr Cardiol 1996; 17: 7–14.CrossRefGoogle ScholarPubMed
Goldberg, DJ, Avitabile, C, McBride, M, et al. Exercise capacity in the Fontan circulation. Cardiol Young 2013; 23: 824–830.CrossRefGoogle ScholarPubMed
Bainbridge, FA. The influence of venous filling upon the rate of the heart. J Physiol 2015; 50: 65–84.CrossRefGoogle Scholar
Claessen, G, La Gerche, A, Van De Bruaene, A, et al. Heart rate reserve in Fontan patients: chronotropic incompetence or hemodynamic limitation? J Am Heart Assoc 2019; 8: e012008.CrossRefGoogle ScholarPubMed
Van De Bruaene, A, La Gerche, A, Claessen, G, et al. Sildenafil improves exercise hemodynamics in Fontan patients. Circ Cardiovasc Imaging 2014; 7: 265–273.Google ScholarPubMed
Ohuchi, H, Negishi, J, Miike, H, et al. Positive pediatric exercise capacity trajectory predicts better adult Fontan physiology rationale for early establishment of exercise habits. Int J Cardiol 2019; 274: 80–87.CrossRefGoogle ScholarPubMed
Schleiger, A, Salzmann, M, Kramer, P, et al. Severity of Fontan-associated liver disease correlates with Fontan hemodynamics. Pediatr Cardiol 2020; 41: 736–746.CrossRefGoogle ScholarPubMed
Hsia, T-Y, Khambadkone, S, Redington, AN, Migliavacca, F, Deanfield, JE, de Leval, MR. Effects of respiration and gravity on infradiaphragmatic venous flow in normal and Fontan patients. Circulation 2000; 102: 148–153.CrossRefGoogle ScholarPubMed
Wasserman, K. Breathing during exercise. N Engl J Med 1978; 298: 780–785.CrossRefGoogle ScholarPubMed