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Effect of right ventricular anatomy on the cardiopulmonary response to exercise. Implications for the Fontan procedure
Incorporation of the right ventricle (RV) into the pulmonary circulation of patients with tricuspid atresia undergoing a Fontan procedure has been advocated. The consequences of this approach on the exercise function of these patients was studied by examining the effects of progressive and steady-st...
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| Published in: | Circulation (New York, N.Y.) N.Y.), 1990-06, Vol.81 (6), p.1811-1817 |
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| container_end_page | 1817 |
| container_issue | 6 |
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| container_title | Circulation (New York, N.Y.) |
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| creator | Rhodes, J Garofano, R P Bowman, Jr, F O Grant, G P Bierman, F Z Gersony, W M |
| description | Incorporation of the right ventricle (RV) into the pulmonary circulation of patients with tricuspid atresia undergoing a Fontan procedure has been advocated. The consequences of this approach on the exercise function of these patients was studied by examining the effects of progressive and steady-state bicycle exercise tests performed by 11 patients with right atrial (RA)-RV Fontan anastomoses, seven patients with RA-pulmonary artery (PA) Fontan anastomoses, 13 patients after repair of tetralogy of Fallot, and 34 normal control patients. All patients were in New York Heart Association class I. The exercise function of the patients undergoing RA-RV and RA-PA Fontan procedures were similar. The achieved peak work loads 60% and 67% of control and peak oxygen consumptions 60% and 64% of control, respectively. Both groups also displayed excessive ventilation, elevated dead space/tidal volume ratios, and depressed cardiac output during steady-state exercise. In contrast, tetralogy of Fallot patients achieved peak work loads and oxygen consumptions 83% of control and maintained normal cardiac outputs and dead space/tidal volume ratios during steady-state exercise. These results suggest that the presence of an RV within the pulmonary circulation of the Fontan patient does not result in improved exercise function. This may be due to the development of obstructive gradients across the RA-RV conduits during exercise or to the RV's negative effect on left ventricular compliance. Moreover, in contrast with the postoperative tetralogy of Fallot patient, the hypoplastic RV of tricuspid atresia may not have sufficient myocardium to assume the active pumping function required by exercise. |
| doi_str_mv | 10.1161/01.cir.81.6.1811 |
| format | article |
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Implications for the Fontan procedure</title><source>EZB Free E-Journals</source><creator>Rhodes, J ; Garofano, R P ; Bowman, Jr, F O ; Grant, G P ; Bierman, F Z ; Gersony, W M</creator><creatorcontrib>Rhodes, J ; Garofano, R P ; Bowman, Jr, F O ; Grant, G P ; Bierman, F Z ; Gersony, W M</creatorcontrib><description>Incorporation of the right ventricle (RV) into the pulmonary circulation of patients with tricuspid atresia undergoing a Fontan procedure has been advocated. The consequences of this approach on the exercise function of these patients was studied by examining the effects of progressive and steady-state bicycle exercise tests performed by 11 patients with right atrial (RA)-RV Fontan anastomoses, seven patients with RA-pulmonary artery (PA) Fontan anastomoses, 13 patients after repair of tetralogy of Fallot, and 34 normal control patients. All patients were in New York Heart Association class I. The exercise function of the patients undergoing RA-RV and RA-PA Fontan procedures were similar. The achieved peak work loads 60% and 67% of control and peak oxygen consumptions 60% and 64% of control, respectively. Both groups also displayed excessive ventilation, elevated dead space/tidal volume ratios, and depressed cardiac output during steady-state exercise. In contrast, tetralogy of Fallot patients achieved peak work loads and oxygen consumptions 83% of control and maintained normal cardiac outputs and dead space/tidal volume ratios during steady-state exercise. These results suggest that the presence of an RV within the pulmonary circulation of the Fontan patient does not result in improved exercise function. This may be due to the development of obstructive gradients across the RA-RV conduits during exercise or to the RV's negative effect on left ventricular compliance. Moreover, in contrast with the postoperative tetralogy of Fallot patient, the hypoplastic RV of tricuspid atresia may not have sufficient myocardium to assume the active pumping function required by exercise.</description><identifier>ISSN: 0009-7322</identifier><identifier>EISSN: 1524-4539</identifier><identifier>DOI: 10.1161/01.cir.81.6.1811</identifier><identifier>PMID: 2344677</identifier><language>eng</language><publisher>United States</publisher><subject>Adolescent ; Adult ; Anastomosis, Surgical ; Child ; Child, Preschool ; Echocardiography, Doppler ; Exercise Test ; Follow-Up Studies ; Heart - physiopathology ; Heart Ventricles - abnormalities ; Heart Ventricles - physiopathology ; Heart Ventricles - surgery ; Hemodynamics ; Humans ; Oxygen Consumption ; Physical Exertion - physiology ; Pulmonary Artery - physiopathology ; Pulmonary Artery - surgery ; Respiration - physiology ; Tetralogy of Fallot - physiopathology ; Tetralogy of Fallot - surgery ; Tricuspid Valve - abnormalities ; Tricuspid Valve - physiopathology ; Tricuspid Valve - surgery</subject><ispartof>Circulation (New York, N.Y.), 1990-06, Vol.81 (6), p.1811-1817</ispartof><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c443t-810644adaf41c2a41b6ef0452174dc380787cdc49487201b6331b8e5844f67683</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,786,790,27957,27958</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/2344677$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rhodes, J</creatorcontrib><creatorcontrib>Garofano, R P</creatorcontrib><creatorcontrib>Bowman, Jr, F O</creatorcontrib><creatorcontrib>Grant, G P</creatorcontrib><creatorcontrib>Bierman, F Z</creatorcontrib><creatorcontrib>Gersony, W M</creatorcontrib><title>Effect of right ventricular anatomy on the cardiopulmonary response to exercise. Implications for the Fontan procedure</title><title>Circulation (New York, N.Y.)</title><addtitle>Circulation</addtitle><description>Incorporation of the right ventricle (RV) into the pulmonary circulation of patients with tricuspid atresia undergoing a Fontan procedure has been advocated. The consequences of this approach on the exercise function of these patients was studied by examining the effects of progressive and steady-state bicycle exercise tests performed by 11 patients with right atrial (RA)-RV Fontan anastomoses, seven patients with RA-pulmonary artery (PA) Fontan anastomoses, 13 patients after repair of tetralogy of Fallot, and 34 normal control patients. All patients were in New York Heart Association class I. The exercise function of the patients undergoing RA-RV and RA-PA Fontan procedures were similar. The achieved peak work loads 60% and 67% of control and peak oxygen consumptions 60% and 64% of control, respectively. Both groups also displayed excessive ventilation, elevated dead space/tidal volume ratios, and depressed cardiac output during steady-state exercise. In contrast, tetralogy of Fallot patients achieved peak work loads and oxygen consumptions 83% of control and maintained normal cardiac outputs and dead space/tidal volume ratios during steady-state exercise. These results suggest that the presence of an RV within the pulmonary circulation of the Fontan patient does not result in improved exercise function. This may be due to the development of obstructive gradients across the RA-RV conduits during exercise or to the RV's negative effect on left ventricular compliance. Moreover, in contrast with the postoperative tetralogy of Fallot patient, the hypoplastic RV of tricuspid atresia may not have sufficient myocardium to assume the active pumping function required by exercise.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Anastomosis, Surgical</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Echocardiography, Doppler</subject><subject>Exercise Test</subject><subject>Follow-Up Studies</subject><subject>Heart - physiopathology</subject><subject>Heart Ventricles - abnormalities</subject><subject>Heart Ventricles - physiopathology</subject><subject>Heart Ventricles - surgery</subject><subject>Hemodynamics</subject><subject>Humans</subject><subject>Oxygen Consumption</subject><subject>Physical Exertion - physiology</subject><subject>Pulmonary Artery - physiopathology</subject><subject>Pulmonary Artery - surgery</subject><subject>Respiration - physiology</subject><subject>Tetralogy of Fallot - physiopathology</subject><subject>Tetralogy of Fallot - surgery</subject><subject>Tricuspid Valve - abnormalities</subject><subject>Tricuspid Valve - physiopathology</subject><subject>Tricuspid Valve - surgery</subject><issn>0009-7322</issn><issn>1524-4539</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1990</creationdate><recordtype>article</recordtype><recordid>eNo9kM1r3DAQxUVoSTdp77kUdOrNjsaSJflYlnwsBAIhPQutPEoUbMuV5ND89_E2S07D8N7vDfMIuQBWA0i4ZFC7kGoNtaxBA5yQDbSNqETLuy9kwxjrKsWb5hs5y_llXSVX7Sk5bbgQUqkNeb3yHl2h0dMUnp4LfcWppOCWwSZqJ1vi-EbjRMszUmdTH-K8DGOcbHqjCfMcp4y0RIr_MLmQsaa7cR6CsyWsEvUx_Uev41TsROcUHfZLwu_kq7dDxh_HeU7-XF89bm-ru_ub3fb3XeWE4KXSwKQQtrdegGusgL1Ez0TbgBK945oprVzvRCe0atiqcg57ja0WwkslNT8nvz5y18t_F8zFjCE7HAY7YVyyUZ3qoIV2NbIPo0sx54TezCmM65cGmDlUbRiY7e7BaDDSHKpekZ_H7GU_Yv8JHLvl79tye1M</recordid><startdate>19900601</startdate><enddate>19900601</enddate><creator>Rhodes, J</creator><creator>Garofano, R P</creator><creator>Bowman, Jr, F O</creator><creator>Grant, G P</creator><creator>Bierman, F Z</creator><creator>Gersony, W M</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>19900601</creationdate><title>Effect of right ventricular anatomy on the cardiopulmonary response to exercise. Implications for the Fontan procedure</title><author>Rhodes, J ; Garofano, R P ; Bowman, Jr, F O ; Grant, G P ; Bierman, F Z ; Gersony, W M</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c443t-810644adaf41c2a41b6ef0452174dc380787cdc49487201b6331b8e5844f67683</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1990</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Anastomosis, Surgical</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Echocardiography, Doppler</topic><topic>Exercise Test</topic><topic>Follow-Up Studies</topic><topic>Heart - physiopathology</topic><topic>Heart Ventricles - abnormalities</topic><topic>Heart Ventricles - physiopathology</topic><topic>Heart Ventricles - surgery</topic><topic>Hemodynamics</topic><topic>Humans</topic><topic>Oxygen Consumption</topic><topic>Physical Exertion - physiology</topic><topic>Pulmonary Artery - physiopathology</topic><topic>Pulmonary Artery - surgery</topic><topic>Respiration - physiology</topic><topic>Tetralogy of Fallot - physiopathology</topic><topic>Tetralogy of Fallot - surgery</topic><topic>Tricuspid Valve - abnormalities</topic><topic>Tricuspid Valve - physiopathology</topic><topic>Tricuspid Valve - surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rhodes, J</creatorcontrib><creatorcontrib>Garofano, R P</creatorcontrib><creatorcontrib>Bowman, Jr, F O</creatorcontrib><creatorcontrib>Grant, G P</creatorcontrib><creatorcontrib>Bierman, F Z</creatorcontrib><creatorcontrib>Gersony, W M</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Circulation (New York, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rhodes, J</au><au>Garofano, R P</au><au>Bowman, Jr, F O</au><au>Grant, G P</au><au>Bierman, F Z</au><au>Gersony, W M</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effect of right ventricular anatomy on the cardiopulmonary response to exercise. Implications for the Fontan procedure</atitle><jtitle>Circulation (New York, N.Y.)</jtitle><addtitle>Circulation</addtitle><date>1990-06-01</date><risdate>1990</risdate><volume>81</volume><issue>6</issue><spage>1811</spage><epage>1817</epage><pages>1811-1817</pages><issn>0009-7322</issn><eissn>1524-4539</eissn><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-2</notes><notes>content type line 23</notes><abstract>Incorporation of the right ventricle (RV) into the pulmonary circulation of patients with tricuspid atresia undergoing a Fontan procedure has been advocated. The consequences of this approach on the exercise function of these patients was studied by examining the effects of progressive and steady-state bicycle exercise tests performed by 11 patients with right atrial (RA)-RV Fontan anastomoses, seven patients with RA-pulmonary artery (PA) Fontan anastomoses, 13 patients after repair of tetralogy of Fallot, and 34 normal control patients. All patients were in New York Heart Association class I. The exercise function of the patients undergoing RA-RV and RA-PA Fontan procedures were similar. The achieved peak work loads 60% and 67% of control and peak oxygen consumptions 60% and 64% of control, respectively. Both groups also displayed excessive ventilation, elevated dead space/tidal volume ratios, and depressed cardiac output during steady-state exercise. In contrast, tetralogy of Fallot patients achieved peak work loads and oxygen consumptions 83% of control and maintained normal cardiac outputs and dead space/tidal volume ratios during steady-state exercise. These results suggest that the presence of an RV within the pulmonary circulation of the Fontan patient does not result in improved exercise function. This may be due to the development of obstructive gradients across the RA-RV conduits during exercise or to the RV's negative effect on left ventricular compliance. Moreover, in contrast with the postoperative tetralogy of Fallot patient, the hypoplastic RV of tricuspid atresia may not have sufficient myocardium to assume the active pumping function required by exercise.</abstract><cop>United States</cop><pmid>2344677</pmid><doi>10.1161/01.cir.81.6.1811</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Circulation (New York, N.Y.), 1990-06, Vol.81 (6), p.1811-1817 |
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| subjects | Adolescent Adult Anastomosis, Surgical Child Child, Preschool Echocardiography, Doppler Exercise Test Follow-Up Studies Heart - physiopathology Heart Ventricles - abnormalities Heart Ventricles - physiopathology Heart Ventricles - surgery Hemodynamics Humans Oxygen Consumption Physical Exertion - physiology Pulmonary Artery - physiopathology Pulmonary Artery - surgery Respiration - physiology Tetralogy of Fallot - physiopathology Tetralogy of Fallot - surgery Tricuspid Valve - abnormalities Tricuspid Valve - physiopathology Tricuspid Valve - surgery |
| title | Effect of right ventricular anatomy on the cardiopulmonary response to exercise. Implications for the Fontan procedure |
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