Exercise-induced systemic venous hypertension in the Fontan circulation

Devaraj Navaratnam, Samantha Fitzsimmons, Michael Grocott, Harry B. Rossiter, Yaso Emmanuel, Gerard Paul Diller, Timothy Gordon-Walker, Sandy Jack, Nick Sheron, John Pappachan, Jayant Nick Pratap, Joseph J. Vettukattil, Gruschen Veldtman*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

28 Citations (Scopus)

Abstract

Increasingly end-organ injury is being demonstrated late after institution of the Fontan circulation, particularly liver fibrosis and cirrhosis. The exact mechanisms for these late phenomena remain largely elusive. Hypothesizing that exercise induces precipitous systemic venous hypertension and insufficient cardiac output for the exercise demand, that is, a possible mechanism for end-organ injury, we sought to demonstrate the dynamic exercise responses in systemic venous perfusion (SVP) and concurrent end-organ perfusion. Ten stable Fontan patients and 9 control subjects underwent incremental cycle ergometry-based cardiopulmonary exercise testing. SVP was monitored in the right upper limb, and regional tissue oxygen saturation was monitored in the brain and kidney using near-infrared spectroscopy. SVP rose profoundly in concert with workload in the Fontan group, described by the regression equation 15.97 + 0.073 watts per mm Hg. In contrast, SVP did not change in healthy controls. Regional renal (p <0.01) and cerebral tissue saturations (p <0.001) were significantly lower and decrease more rapidly in Fontan patients. We conclude that in a stable group of adult patients with Fontan circulation, high-intensity exercise was associated with systemic venous hypertension and reduced systemic oxygen delivery. This physiological substrate has the potential to contribute to end-organ injury.

Original languageEnglish
Pages (from-to)1667-1671
Number of pages5
JournalAmerican Journal of Cardiology
Volume117
Issue number10
DOIs
Publication statusPublished - 15 May 2016
Externally publishedYes

Bibliographical note

Funding Information:
Dr Veldtman has received approval for a research grant from United Therapeutics to study the pulmonary vascular bed in Fontan patients. The other authors have no conflicts of interest to disclose.

Publisher Copyright:
© 2016 Elsevier Inc. All rights reserved.

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