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Cerebral Hemodynamics in the Presence of Decreased Systemic Venous Compliance in Patients with Fontan Physiology May Limit Anaerobic Exercise Capacity

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Abstract

Patients who have had the Fontan procedure report poor exercise performance. Fontan subjects can tolerate a higher level of sub maximal activity than might be anticipated from Vo 2, suggesting a different mechanism of exercise limitation. Near-infrared spectroscopy (NIRS) provides a non-invasive, continuous method to monitor regional tissue oxygenation (rSO2) and thereby a window into regional oxygen supply–demand relationships. We hypothesized that Fontan patients would have altered rSO2 trends from normal population that might reflect the mechanisms of exercise limitation. All the patients without structural or acquired heart disease and Fontan patients were eligible for inclusion if they were ordered to undergo cardiopulmonary exercise testing (CPET). Four-site regional rSO2 were recorded continuously during exercise. The difference between the oxyhemoglobin saturation measured by pulse oximetry (Spo 2) and NIRS (rSO2) was computed as the regional arterial–venous saturation difference (AVDO2). A total of 33 normal subjects and five Fontan subjects scheduled for CPET were recruited. None of the Fontan subjects had a fenestration of the conduit. In the cerebral circulation, the Fontan patients have a significantly higher initial slope of increasing AVDO2 compared with normals. After vAT, the AVDO2 slope is flat for Fontan patients (p = 0.02). There is also a substantially larger rebound of cerebral rSO2 than in normal subjects after QT (p < 0.0001). Reduced anaerobic exercise capacity in Fontan patients may be secondary to limitation of cerebral blood flow, secondary to low systemic venous compliance due to absence of a sub-pulmonary ventricle, and augmented hyperventilatory response during exercise.

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Acknowledgments

We acknowledge the invaluable logistical support and coordination of this research provided by Mary M. Krolikowski. We also thank Aniko Szabo and Scott Jackson for statistical analysis. Clinical trial registration information: Registration No. NCT00556231 (available at: http://www.clinicaltrials.gov/ct2/show/NCT00556231?term=NIRS&rank=5). Grant support came from a Pilot Innovative Research Award, Children’s Research Institute, Children’s Health System, Milwaukee, WI.

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Authors and Affiliations

  1. Department of Pediatrics, Division of Cardiology and Critical Care, Medical College of Wisconsin, Milwaukee, WI, USA

    Rohit P. Rao

  2. Herma Heart Center, Children’s Hospital of Wisconsin, Milwaukee, WI, USA

    Michael J. Danduran

  3. Department of Anesthesia, Division of Pediatric Anesthesia, Medical College of Wisconsin, Milwaukee, WI, USA

    George M. Hoffman

  4. Department of Pediatrics, Division of Critical Care, Medical College of Wisconsin, Milwaukee, WI, USA

    Nancy S. Ghanayem

  5. Department of Pediatrics, Division of Cardiology, Medical College of Wisconsin, Milwaukee, WI, USA

    Stuart Berger & Peter C. Frommelt

Authors
  1. Rohit P. Rao
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  2. Michael J. Danduran
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  3. George M. Hoffman
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  4. Nancy S. Ghanayem
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  5. Stuart Berger
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  6. Peter C. Frommelt
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Correspondence to Rohit P. Rao.

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Rao, R.P., Danduran, M.J., Hoffman, G.M. et al. Cerebral Hemodynamics in the Presence of Decreased Systemic Venous Compliance in Patients with Fontan Physiology May Limit Anaerobic Exercise Capacity. Pediatr Cardiol 31, 208–214 (2010). https://doi.org/10.1007/s00246-009-9585-0

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  • DOI: https://doi.org/10.1007/s00246-009-9585-0

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