Relation between ventricular diastolic function and exercise capacity in patients after Fontan operation

  • Dr Lidia Tomkiewicz-Pajak, Jahn Paul II Hospital Krakow, Poland, Poland
  • Dr Jacek Kolcz, Department of Pediatric Cardiac Surgery, Polish - American Children’s Hospital, Jagiellonian University Krakow, Pol, Poland
  • Prof Janusz Skalski, Department of Pediatric Cardiac Surgery, Polish - American Children’s Hospital, Jagiellonian University Krakow, Pol, Poland
  • Prof Piotr Podolec, Jahn Paul II Hospital Krakow, Poland, Poland
  • Monika Pieculewicz, Jahn Paul II Hospital Krakow, Poland, Poland
  • Wieslawa Tracz, Jahn Paul II Hospital Krakow, Poland, Poland

    • Patients who have undergone Fontan operation (FO) may suffer from both
    systolic and diastolic ventricle dysfunction. Diastolic dysfunction can
    decrease exercise tolerance by elevation of pulmonary wedge pressure.
    Resent studies show a prognostic value of parameters of cardiopulmonary
    exercise test (CPX )-peak oxygen uptake (VO2peak), peak ventilatory
    equivalent of carbon dioxide (VE/VCO2) in patients with heart failure.
    The aim of the study was to assess the role of ventricular diastolic
    dysfunction in exercise capacity in patients after FO assessed by CPX.
    Methods: We investigated fifteen patients (9F; 6M) after stage FO with ventricle
    of left ventricular morphology aged 17,6±6,1 years in NYHA I-II. Pulse-wave Doppler
    signals from the mitral inflow and tissue Doppler imaging of the mitral
    annulus were obtained. All the patients underwent symptom limited CPX.
    We analyzed parameters: mitral annulus systolic velocity (S), early diastolic velocity (E’), E wave peak velocity, E/E’ ratio, exercise time, oxygen uptake at anaerobic threshold (AT), VO2peak and (VE/VCO2).
    Results: The mean E/E’ ratio had significant positive correlation with patients' age (r=0,73; p<0,01) and VE/VCO2 (p=0,93; p<0,01). S velocity showed a positive correlation with VO2peak (r=0,82 p<0,01). There was no correlation between echocardiographic Doppler and CPX parameters.
    Conclusion: Ventricular diastolic dysfunction reduce exercise capacity in patients after Fontan operation. E/E’ ratio increases with age
    and correlates with ventilator equivalent of carbon dioxide (VE/VCO2), mitral annulus systolic velocity correlates with oxygen uptake.