Effect of Fontan geometry on exercise haemodynamics and its potential implications

Elaine Tang, Z. Wei, Kevin K. Whitehead, Reza H. Khiabani, Maria Restrepo, Lucia Mirabella, James Bethel, Stephen M. Paridon, Bradley S. Marino, Mark A. Fogel, Ajit P. Yoganathan*

*Corresponding author for this work

Research output: Contribution to journalArticle

17 Scopus citations

Abstract

Objective Exercise intolerance afflicts Fontan patients with total cavopulmonary connections (TCPCs) causing a reduction in quality of life. Optimising TCPC design is hypothesised to have a beneficial effect on exercise capacity. This study investigates relationships between TCPC geometries and exercise haemodynamics and performance. Methods This study included 47 patients who completed metabolic exercise stress test with cardiac magnetic resonance (CMR). Phase-contrast CMR images were acquired immediately following supine lower limb exercise. Both anatomies and exercise vessel flow rates at ventilatory anaerobic threshold (VAT) were extracted. The vascular modelling toolkits were used to analyse TCPC geometries. Computational simulations were performed to quantify TCPC indexed power loss (iPL) at VAT. Results A highly significant inverse correlation was found between the TCPC diameter index, which factors in the narrowing of TCPC vessels, with iPL at VAT (r=0.723, p<0.001) but positive correlations with exercise performance variables, including minute oxygen consumption (VO 2) at VAT (r=0.373, p=0.01), VO 2 at peak exercise (r=0.485, p=0.001) and work at VAT/weight (r=0.368, p=0.01). iPL at VAT was negatively correlated with VO 2 at VAT (r=0.337, p=0.02), VO 2 at peak exercise (r=0.394, p=0.007) and work at VAT/weight (r=0.208, p=0.17). Conclusions Eliminating vessel narrowing in TCPCs and reducing elevated iPL at VAT could enhance exercise tolerance for patients with TCPCs. These findings could help plan surgical or catheter-based strategies to improve patients' exercise capacity.

Original languageEnglish (US)
Pages (from-to)1806-1812
Number of pages7
JournalHeart
Volume103
Issue number22
DOIs
StatePublished - Nov 1 2017

Keywords

  • congenital heart disease; Fontan procedure; exercise hemodynamics; computational fluid dynamics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Tang, E., Wei, Z., Whitehead, K. K., Khiabani, R. H., Restrepo, M., Mirabella, L., Bethel, J., Paridon, S. M., Marino, B. S., Fogel, M. A., & Yoganathan, A. P. (2017). Effect of Fontan geometry on exercise haemodynamics and its potential implications. Heart, 103(22), 1806-1812. https://doi.org/10.1136/heartjnl-2016-310855