Exercise capacity improves after transcatheter closure of the Fontan fenestration in children.
OBJECTIVE
This study evaluated the aerobic capacity, exercise capacity, and arterial oxygen saturation (O(2)Sat) in children before and after transcatheter Fontan fenestration closure.


METHODS
Observational study comparing exercise parameters and hemodynamics before and after transcatheter fenestration closure in Fontan patients.


METHODS
Working capacity, exercise duration, oxygen consumption (VO(2)), and arterial O(2)Sat were evaluated during aerobic exercise.


RESULTS
Twenty patients (mean age 11.4 years) underwent standardized exercise testing before and after fenestration closure. Twelve patients underwent cycle ergometry testing (mean age 14.8 years) (group 1), and eight younger patients (mean age 6.4 years) underwent Bruce treadmill testing (group 2). The same exercise protocol was used in each patient before and after fenestration closure (interval between tests: 118 +/- 142 days). Immediately following fenestration closure at cardiac catheterization, cardiac index decreased (3.0 to 2.1 L/minute/m(2)) and Fontan pressure increased (11 +/- 2 to 12 +/- 2 mm Hg) with an increased arterial saturation (92 to 96%) (P < .001). The total group demonstrated no significant change in pre- and postclosure maximal heart rates (164 +/- 21 and 169 +/- 19 bpm). Rest and exercise O(2)Sat increased (89 and 82 to 95 and 92%) (P < .0001). Exercise duration increased (7.7 +/- 1.9 to 9.2 +/- 2.4 minutes) (P < .0005). Maximal VO(2), indexed maximal VO(2), and total working capacity in kilopond-meters (kpm) increased (1.2 +/- 0.5, 27 +/- 7 and 2466 +/- 1012 to 1.3 +/- 0.4 L/minute, 31 +/- 9 mL/kg/minute and 2869 +/- 1051 kpm, respectively) (P < .005).


CONCLUSIONS
In children with a univentricular heart after Fontan palliation, transcatheter fenestration closure improves exercise arterial O(2)Sat and aerobic capacity despite a restricted resting cardiac output documented by catheterization immediately after the closure procedure.
Mays
Wayne A
WA
Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA. wayne.mays@cchmc.org
Border
William L
WL
Knecht
Sandra K
SK
Gerdes
Yvette M
YM
Pfriem
Holly
H
Claytor
Randal P
RP
Knilans
Timothy K
TK
Hirsch
Russel
R
Mone
Suzanne M
SM
Beekman
Robert H
RH
D000293:Adolescent; D006328:Cardiac Catheterization; D002648:Child; D002675:Child, Preschool; D005080:Exercise Test; D017079:Exercise Tolerance; D005260:Female; D018729:Fontan Procedure; D006330:Heart Defects, Congenital / Q000601:surgery*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D010100:Oxygen / Q000097:blood; D011184:Postoperative Period; D019736:Prostheses and Implants; D012189:Retrospective Studies
D010100:Oxygen