Physical activity levels in children and adolescents are reduced after the Fontan procedure, independent of exercise capacity, and are associated with lower perceived general health

McCrindle, Brian W.; Williams, Richard V.; Mital, Seema; Clark, Bernard J.; Russell, Jennifer; Klein, Gloria L.; Eisenmann, Joey C.

doi:10.1136/adc.2006.105239

Cited by 204 publications

(217 citation statements)

References 41 publications

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“…The reduced capacity to increase CO with exercise in SV circulations has been well documented in the literature (5,15,17,23). However, the exact quantitative relationship between R TCPC and this phenomenon has been unclear, primarily because of two reasons: 1) lack of appropriate methods for quantifying TCPC efficiency and 2) the complex interrelationships that exist between the respiratory, skeletal, and cardiovascular system that make it difficult to establish correlations between the TCPC and exercise capacity.…”

Section: Discussionmentioning

confidence: 99%

“…Although postoperative survival is excellent, with some centers having a mortality of Ͻ1%, studies have repeatedly demonstrated poor functional outcome in survivors (15)(16)(17)(18), including significantly reduced exercise capacity, diminished cardiac output (CO), and risks of heart failure (5, 10 -12, 16, 32, 35, 36, 40). Among all the parameters that come into play, decreased cardiac function in these patients seems to be one of the key players responsible for the poor functional outcome (26,35).…”

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confidence: 99%

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The total cavopulmonary connection resistance: a significant impact on single ventricle hemodynamics at rest and exercise

Sundareswaran¹,

Pekkan²,

Dasi³

et al. 2008

American Journal of Physiology-Heart and Circulatory Physiology

110

140

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AP. The total cavopulmonary connection resistance: a significant impact on single ventricle hemodynamics at rest and exercise. Am J Physiol Heart Circ Physiol 295: H2427-H2435, 2008. First published October 17, 2008 doi:10.1152/ajpheart.00628.2008Little is known about the impact of the total cavopulmonary connection (TCPC) on resting and exercise hemodynamics in a single ventricle (SV) circulation. The aim of this study was to elucidate this mechanism using a lumped parameter model of the SV circulation. Pulmonary vascular resistance (1.96 Ϯ 0.80 WU) and systemic vascular resistances (18.4 Ϯ 7.2 WU) were obtained from catheterization data on 40 patients with a TCPC. TCPC resistances (0.39 Ϯ 0.26 WU) were established using computational fluid dynamic simulations conducted on anatomically accurate three-dimensional models reconstructed from MRI (n ϭ 16). These parameters were used in a lumped parameter model of the SV circulation to investigate the impact of TCPC resistance on SV hemodynamics under resting and exercise conditions. A biventricular model was used for comparison. For a biventricular circulation, the cardiac output (CO) dependence on TCPC resistance was negligible (sensitivity ϭ Ϫ0.064 l ⅐ min Ϫ1 ⅐ WU Ϫ1 ) but not for the SV circulation (sensitivity ϭ Ϫ0.88 l ⅐ min Ϫ1 ⅐ WU Ϫ1 ). The capacity to increase CO with heart rate was also severely reduced for the SV. At a simulated heart rate of 150 beats/min, the SV patient with the highest resistance (1.08 WU) had a significantly lower increase in CO (20.5%) compared with the SV patient with the lowest resistance (50%) and normal circulation (119%). This was due to the increased afterload (ϩ35%) and decreased preload (Ϫ12%) associated with the SV circulation. In conclusion, TCPC resistance has a significant impact on resting hemodynamics and the exercise capacity of patients with a SV physiology. mathematical modeling; cardiac function; congenital heart defects; magnetic resonance imaging THE FONTAN PROCEDURE, composing of connecting the systemic and pulmonary circulation in series via the total cavopulmonary connection (TCPC), is the primary palliative option for physiological correction of single ventricle (SV) congenital heart diseases (2, 3). Although postoperative survival is excellent, with some centers having a mortality of Ͻ1%, studies have repeatedly demonstrated poor functional outcome in survivors (15-18), including significantly reduced exercise capacity, diminished cardiac output (CO), and risks of heart failure (5, 10 -12, 16, 32, 35, 36, 40). Among all the parameters that come into play, decreased cardiac function in these patients seems to be one of the key players responsible for the poor functional outcome (26, 35). However, the impact of the surgically altered TCPC on cardiac function or functional outcome has not been well understood.Poor cardiac function in SV patients can be associated with many factors. For example, Fogel et al. (8) demonstrated that the presence of the lateral tunnel baffle restricted the motion of the atrioventric...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

The total cavopulmonary connection resistance: a significant impact on single ventricle hemodynamics at rest and exercise

Sundareswaran¹,

Pekkan²,

Dasi³

et al. 2008

American Journal of Physiology-Heart and Circulatory Physiology

110

140

View full text Add to dashboard Cite

show abstract

“…Although some of this exercise dysfunction could be related to residual hemodynamic defects, inactivity and deconditioning (often because of restrictions inappropriately imposed by family members, teachers, coaches, or the patients themselves) undoubtedly contribute to this problem. 584,585 This component of their disability should theoretically respond favorably to exercise training programs.…”

Section: Exercise Training In Padmentioning

confidence: 99%

Exercise Standards for Testing and Training

Fletcher¹,

Ades²,

Kligfield³

et al. 2013

Circulation

1,685

760

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“…21 This indicates that patients who exercise vigorously for the recommended 60 minutes per day but also have prolonged sedentary periods will continue to be at increased risk. 18 As a group, patients with CHD have lower levels of daily physical activity [26][27][28][29] and a higher prevalence of obesity and other cardiovascular risk factors 30 than healthy children. Given the high survival rates for most CHD patients well into adulthood, these risk factors for acquired heart disease are becoming increasingly important, as is the need for higher levels of lifelong physical activity levels to combat them.…”

Section: Benefits Of Physical Activitymentioning

confidence: 99%

Promotion of Physical Activity for Children and Adults With Congenital Heart Disease

Longmuir¹,

Ferranti²,

Hayman³

et al. 2013

Circulation

255

171

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The American Heart Association recognizes the importance of physically active lifestyles to the health and well-being of children and adults with congenital heart defects. Counseling of patients with congenital heart defects should emphasize the importance of daily physical activity and decreasing sedentary behavior as appropriate for the patient’s clinical status. The suggested practices are based on relevant research regarding the benefits of physical activity for healthy children and adults, because research on physical activity among patients with congenital heart defects is lacking. There is no evidence regarding whether or not there is a need to restrict recreational physical activity among patients with congenital heart defects, apart from those with rhythm disorders. It is important to recognize that most patients with congenital heart defects are relatively sedentary and that the physical and psychosocial health benefits of physical activity are important for this population, which is at risk for exercise intolerance, obesity, and psychosocial morbidities. Therefore, counseling to encourage daily participation in appropriate physical activity should be a core component of every patient encounter.

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Physical activity levels in children and adolescents are reduced after the Fontan procedure, independent of exercise capacity, and are associated with lower perceived general health

Abstract: Physical activity levels are reduced after Fontan, independent of exercise capacity, and are associated with lower perceived general health but not other aspects of functional status.

Cited by 204 publications

References 41 publications

The total cavopulmonary connection resistance: a significant impact on single ventricle hemodynamics at rest and exercise

The total cavopulmonary connection resistance: a significant impact on single ventricle hemodynamics at rest and exercise

Exercise Standards for Testing and Training

Promotion of Physical Activity for Children and Adults With Congenital Heart Disease

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