Exercise capacity in adult patients after Fontan procedure. (RCD code: IV‑5B.1)

Monika Smaś‑Suska, P. Weryński, N. Dłużniewska, M. Olszowska, P. Podolec, L. Tomkiewicz-Pajak
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引用次数: 2

Abstract

Background: The aim of Fontan procedure is to restore a balance between pulmonary and systemic circulation and improve or nearly normalize arterial saturation in patients with functionally univentricular heart. Nevertheless, due to the lack of subpulmonary pump, the circulatory system becomes haemodynamically less efficient, what can lead to the impairment of exercise capacity. Aim: The aim of the study was to investigate exercise capacity by means of cardiopulmonary exercise test and pulmonary function tests, of 37 adult Fontan patients with regard to the time passed from the index procedure. The patients were divided into 3 groups: group I – up to 15 years post procedure; group II – 16–20 years, group III – more than 20 years after Fontan procedure). Results: 37 Fontan patients (mean age was 24.4 ±5.7 years, 40% of women) were enrolled in the study. The mean postoperative time was 19.4 ±5.1 (13–30) years. Mean, peak oxygen consumption (VO2peak) was 22.7 ±7.1 ml/kg/min (64.2 ±18.5% of predicted value). According to postoperative time a significant increase of ventilatory equivalent of carbon dioxide (VE/VCO2) (p = 0.033) and significant decrease of forced expiratory volume in 1 s/ vital capacity (FEV1%VC) between group 2 and 3 (p = 0.026) were observed. Additionally, the age of the patients correlated negatively with and heart rate (HR) (r = -0.360, p <0.05) and peak oxygen consumption (VO2peak) (r = -0,337, p < 0.05). Moreover, age at Fontan operation and time after Fontan procedure was related to ventilator equivalent of oxygen (VE/VO2) (r = -0,343, p <0.05, and r = 0.393, p <0.05). Single ventricle ejection fraction (SVEF) and atrioventricular regurgitation degree did not corresponded with cardiopulmonary exercise test (CPET) values. Conclusions: Results highlight the complex problem of diminished exercise capacity of Fontan patients depending on the time passed from the procedure. Exercise tolerance deteriorates in time: VE/VCO2 increases, FEV1/VC markedly lowers in a group of Fontan patients at 20 years follow-up. JRCD 2016; 2 (8): 254–258
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Fontan手术后成人患者的运动能力。(RCD代码:IV‑5B.1)
背景:Fontan手术的目的是恢复肺循环和体循环之间的平衡,改善或接近正常的动脉饱和度。然而,由于缺乏肺下泵,循环系统的血液动力学效率降低,这可能导致运动能力的损害。目的:本研究的目的是通过心肺运动试验和肺功能试验,探讨37例成年Fontan患者的运动能力,以及从指标程序经过的时间。患者分为3组:第一组(术后15年);II组- 16-20岁,III组-方丹手术后20岁以上)。结果:37例Fontan患者(平均年龄24.4±5.7岁,女性占40%)入组研究。术后平均时间19.4±5.1(13-30)年。平均峰值耗氧量(VO2peak)为22.7±7.1 ml/kg/min,为预测值的64.2±18.5%。按术后时间分,2、3组通气当量二氧化碳(VE/VCO2)显著升高(p = 0.033), 1 s/肺活量用力呼气量(FEV1%VC)显著降低(p = 0.026)。患者年龄与心率(HR) (r = -0.360, p <0.05)、最大耗氧量(VO2peak) (r = -0,337, p <0.05)呈负相关。此外,Fontan手术年龄和术后时间与呼吸机耗氧量(VE/VO2)相关(r = -0,343, p <0.05, r = 0.393, p <0.05)。单心室射血分数(SVEF)和房室反流程度与心肺运动试验(CPET)值不一致。结论:结果突出了Fontan患者运动能力下降的复杂问题,这取决于手术后的时间。运动耐量随时间的推移而恶化:20年随访时,Fontan患者组VE/VCO2升高,FEV1/VC显著降低。JRCD 2016;2 (8): 254-258
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来源期刊
Journal of Rare Cardiovascular Diseases
Journal of Rare Cardiovascular Diseases Medicine-Cardiology and Cardiovascular Medicine
自引率
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审稿时长
23 weeks
期刊介绍: Journal of Rare Cardiovascular Diseases (JRCD) is an international, quarterly issued, peer-reviewed, open access, online journal that keeps cardiologists and non-cardiologists up-to-date with rare disorders of the heart and vessels. The Journal publishes fine quality review articles, original, basic and clinical sciences research papers, either positive or negative, case reports and articles on public health issues in the field of rare cardiovascular diseases and orphan cardiovascular drugs. Topics of interest include, but are not limited to the following areas: (1) rare diseases of systemic circulation (2) rare diseases of pulmonary circulation (3) rare diseases of the heart (cardiomyopathies) (4) rare congenital cardiovascular diseases (5) rare arrhythmogenic disorders (6) cardiac tumors and cardiovascular diseases in malignancy (7) cardiovascular diseases in pregnancy (8) basic science (9) quality of life
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