title: Exercise-Induced Systemic Venous Hypertension in the Fontan Circulation.
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.
authors.affiliation: Department of Adult Congenital Heart Disease, Southampton University Hospital, Southampton University School of Medicine, Southampton, United Kingdom.
authors.forename: Devaraj
authors.initials: D
authors.lastname: Navaratnam
authors.affiliation: Department of Adult Congenital Heart Disease, Southampton University Hospital, Southampton University School of Medicine, Southampton, United Kingdom.
authors.forename: Samantha
authors.initials: S
authors.lastname: Fitzsimmons
authors.affiliation: Department of Adult Congenital Heart Disease, Southampton University Hospital, Southampton University School of Medicine, Southampton, United Kingdom.
authors.forename: Michael
authors.initials: M
authors.lastname: Grocott
authors.affiliation: Department of Medicine, Division of Respiratory and Critical Care, Physiology and Medicine, Rehabilitation Clinical Trials Center, Los Angeles Biomedical Research Institute, Harbor-University of California Los Angeles (UCLA) Medical Center, Torrance, California; School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, United Kingdom.
authors.forename: Harry B
authors.initials: HB
authors.lastname: Rossiter
authors.affiliation: Department of Adult Congenital Heart Disease, Southampton University Hospital, Southampton University School of Medicine, Southampton, United Kingdom.
authors.forename: Yaso
authors.initials: Y
authors.lastname: Emmanuel
authors.affiliation: School of Biomedical Sciences, Adult Congenital Heart Disease, University Hospital Münster, Munster, Germany.
authors.forename: Gerard-Paul
authors.initials: GP
authors.lastname: Diller
authors.affiliation: Department of Gastroenterology, Forth Valley Royal Hospital, Edinburgh, United Kingdom.
authors.forename: Timothy
authors.initials: T
authors.lastname: Gordon-Walker
authors.affiliation: Department of Adult Congenital Heart Disease, Southampton University Hospital, Southampton University School of Medicine, Southampton, United Kingdom.
authors.forename: Sandy
authors.initials: S
authors.lastname: Jack
authors.affiliation: Department of Adult Congenital Heart Disease, Southampton University Hospital, Southampton University School of Medicine, Southampton, United Kingdom.
authors.forename: Nick
authors.initials: N
authors.lastname: Sheron
authors.affiliation: Department of Adult Congenital Heart Disease, Southampton University Hospital, Southampton University School of Medicine, Southampton, United Kingdom.
authors.forename: John
authors.initials: J
authors.lastname: Pappachan
authors.affiliation: Department of Anesthesia, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine (UCCOM), Cincinnati, Ohio.
authors.forename: Jayant Nick
authors.initials: JN
authors.lastname: Pratap
authors.affiliation: Department of Pediatric Cardiology, Spectrum Helen De Vos Children's Hospital, Grand Rapids, Michigan.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Vettukattil
authors.affiliation: Adolescent and Adult Congenital Program, Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. Electronic address: Gruschen.veldtman@cchmc.org.
authors.forename: Gruschen
authors.initials: G
authors.lastname: Veldtman
mesh_terms: D000328:Adult; D002302:Cardiac Output; D002496:Central Venous Pressure; D005080:Exercise Test / Q000009:adverse effects*; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D018729:Fontan Procedure / Q000009:adverse effects*; D006330:Heart Defects, Congenital / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D014481:United States / Q000453:epidemiology; D055815:Young Adult