Effects of postural change on oxygen saturation and respiration in patients after the Fontan operation: platypnea and orthodeoxia.
The aim of this study was to assess whether platypnea and orthodeoxia occur in Fontan patients. We divided 14 Fontan patients into 2 groups: 8 patients who had pulmonary arteriovenous fistulas and/or intra-atrial shunts (group A) and 6 patients who had neither pulmonary arteriovenous fistulas nor intra-atrial shunts (group B). They were compared with 9 controls (group C). Arterial oxygen saturation, minute ventilation per body weight and ventilatory equivalent for carbon dioxide were measured in the supine and then sitting positions. In group A, 1 patient had platypnea and 3 patients had orthodeoxia (changes in the saturation from the supine position to the sitting position were -4% to -7%) accompanied with slight hyperpnea, and all 4 patients had both pulmonary arteriovenous fistulas and intra-atrial shunts. Contrary, patients in group B had neither platypnea nor orthodeoxia. The saturation was significantly lower and the minute ventilation was significantly higher in the sitting position than in the supine position in group A (p < 0.05). The other groups showed no significant difference in the saturation or the minute ventilation between the 2 positions. All groups showed the ventilatory equivalent was significantly higher in the sitting position than in the supine position (p < 0.05 to 0.01). We demonstrated platypnea and orthodeoxia in Fontan patients with pulmonary arteriovenous fistulas and intra-atrial shunts. We believe platypnea and orthodeoxia should be regard as a complication in Fontan patients with pulmonary arteriovenous fistulas and/or intra-atrial shunts.
Suzuki
Hiroshi
H
Department of Pediatrics, National Cardiovascular Center, Suita, Osaka, Japan. hsuzukc562@hotmail.com
Ohuchi
Hideo
H
Hiraumi
Yoshimi
Y
Yasuda
Kenji
K
Echigo
Shigeyuki
S
D000293:Adolescent; D000328:Adult; D001164:Arteriovenous Fistula / Q000151:congenital / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006328:Cardiac Catheterization; D016022:Case-Control Studies; D002648:Child; D004417:Dyspnea / Q000503:physiopathology; D004452:Echocardiography; D005080:Exercise Test; D005260:Female; D018729:Fontan Procedure; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D010092:Oximetry; D010100:Oxygen / Q000378:metabolism*; D011187:Posture; D011403:Pronation; D011651:Pulmonary Artery / Q000002:abnormalities; D011659:Pulmonary Gas Exchange; D011667:Pulmonary Veins / Q000002:abnormalities; D012129:Respiratory Function Tests; D018709:Statistics, Nonparametric; D013484:Supination
D010100:Oxygen