Pediatric Cardiology

, Volume 15, Issue 4, pp 170–177 | Cite as

Maximal hemodynamic response after the Fontan procedure: Doppler evaluation during the treadmill test

  • R. G. S. Cortes
  • G. Satomi
  • M. Yoshigi
  • K. Momma
Original Articles


After undergoing the Fontan procedure for congenital heart disease, 16 young patients performed a maximal treadmill test according to the Bruce protocol. The peak velocity of the blood flow in the ascending aorta, stroke index, and cardiac index were measured by continuous-wave Doppler echocardiography at rest and at each stage of the test. The results were compared with those from 18 normal children. The body surface area was similar in the two groups. The endurance time was 37% shorter in the Fontan group than in the control group. From the beginning of exercise until the sixth minute, the increase in stroke index was lower in the Fontan group (NS). After that point, the stroke index was maintained at a high level in the control group but decreased toward its original level in the Fontan group. The response of cardiac index to exercise in the two groups was comparable until the sixth minute, after which the Fontan group failed to maintain an ascending curve. All the hemodynamic values were significantly higher in the control group at maximal exercise; at this point the cardiac index had increased 79% in the Fontan group and 170% in the control group. The subnormal response of the stroke volume at submaximal exercise and the subsequent decrease at maximal exercise following the Fontan procedure are important hemodynamic findings.

Key Words

Cardiac index Continuous-wave Doppler Fontan procedure Maximal exercise capacity Stroke index Treadmill exercise test 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Alboliras ET, Julsrud PR, Danielson GK, et al (1987) Definitive operation for pulmonary atresia with intact ventricular septum.J Thorac Cardiovasc Surg 93:454–464Google Scholar
  2. 2.
    Bar-Or O, Shephard RJ, Allen CL (1971) Cardiac output of 10- to 13-year-old boys and girls during submaximal exercise.J Appl Physiol 30:219–223Google Scholar
  3. 3.
    Bruce RA, Kusumi F, Hosmer D (1973) Maximal oxygen intake and nomographic assessment of functional aerobic impairment in cardiovascular disease.Am Heart J 85:546–562Google Scholar
  4. 4.
    Cumming GR (1978) Maximal exercise capacity of children with heart defects.Am J Cardiol 42:613–619Google Scholar
  5. 5.
    Cumming GR, Everatt D, Hastman L (1978) Bruce treadmill test in children: normal values in a clinic population.Am J Cardiol 41:69–75Google Scholar
  6. 6.
    Daley PJ, Sagar KB, Wann LS (1985) Doppler echocardiographic measurement of flow velocity in the ascending aorta during supine and upright exercise.Br Heart J 54:562–567Google Scholar
  7. 7.
    Driscoll DJ, Danielson GK, Puga FJ, et al (1986) Exercise tolerance and cardiorespiratory response to exercise after the Fontan operation for tricuspid atresia or functional single ventricle.J Am Coll Cardiol 7:1087–1094Google Scholar
  8. 8.
    Driscoll DJ, Feldt RH, Mottram CD, et al (1987) Cardiore-spiratory response to exercise after definitive repair of univentricular atrioventricular connection.Int J Cardiol 17:73–81Google Scholar
  9. 9.
    Fontan F, Baudet E (1971) Surgical repair of tricuspid atresia.Thorax 26:240–248Google Scholar
  10. 10.
    Gewillig MH, Lundstrom UR, Bull C, Wyse RK, Deanfield JE (1990) Exercise responses in patients with congenital heart disease after Fontan repair: patterns and determinants of performance.J Am Coll Cardiol 15:1424–1432Google Scholar
  11. 11.
    Godfrey S, Davies CT, Wozniak E, Barnes CA (1971) Cardio-respiratory response to exercise in normal children.Clin Sci 40:419–431Google Scholar
  12. 12.
    Hagler DJ, Seward JB, Tajik AJ, Ritter DG (1984) Functional assessment of the Fontan operation: combined M-mode, two-dimensional and Doppler echocardiographic studies.J Am Coll Cardiol 4:756–764Google Scholar
  13. 13.
    Humes RA, Feldt RH, Porter J, et al (1988) The modified Fontan operation for asplenia and polysplenia syndromes.J Thorac Cardiovasc Surg 96:212–218Google Scholar
  14. 14.
    Iwase M, Maeda M, Noda S, et al (1990) Continuous wave Doppler echocardiographic evaluation of cardiac output in its application to treadmill exercise.Am J Noninvas Cardiol 4:159–166Google Scholar
  15. 15.
    James FW, Kaplan S, Glueck CHJ, et al (1980) Response of normal children and young adults to controlled bicycle exercise.Circulation 61:902–912Google Scholar
  16. 16.
    Lock JE, Einzig S, Moller JH (1978) Hemodynamic responses to exercise in normal children.Am J Cardiol 41: 1278–1284Google Scholar
  17. 17.
    Rhodes J, Garofano RP, Bowman FO, et al (1990) Effect of right ventricular anatomy on the cardiopulmonary response to exercise: implications for the Fontan procedure.Circulation 81:1811–1817Google Scholar
  18. 18.
    Shachar GB, Fuhrman BP, Wang Y, Lucas RV, Lock JE (1982) Rest and exercise hemodynamics after the Fontan procedure.Circulation 65: 1043–1048Google Scholar

Copyright information

© Springer-Verlag New York Inc 1994

Authors and Affiliations

  • R. G. S. Cortes
    • 2
  • G. Satomi
    • 1
  • M. Yoshigi
    • 1
  • K. Momma
    • 1
  1. 1.Department of Pediatric Cardiology, The Heart Institute of JapanTokyo Women's Medical CollegeTokyoJapan
  2. 2.Division of CardiologyNagano Children's HospitalNaganoJapan

Personalised recommendations