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Exercise-induced systemic venous hypertension in the Fontan circulation

Exercise-induced systemic venous hypertension in the Fontan circulation
Exercise-induced systemic venous hypertension in the Fontan circulation
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.
0002-9149
1167-1671
Navaratnam, D.
22c1ff56-3b8a-4acb-b6af-dc5f2d8941c4
Fitzsimmons, S.
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Grocott, M.
1e87b741-513e-4a22-be13-0f7bb344e8c2
Rossiter, H.B.
b290e978-2000-44d2-a7fd-09f3725ab50c
Emmanuel, Y.
f0961720-4610-409d-b347-b47328c9d6bb
Diller, G.P.
c8a575ad-67f9-4148-97ac-87c204bf242b
Gordon-Walker, T.
85cec5fd-0794-4e1b-bba6-b14a5ddaad80
Jack, S.
d824ec2e-e92f-4e68-8fa5-953dfec46208
Sheron, N.
cbf852e3-cfaa-43b2-ab99-a954d96069f1
Pappachan, J.
f5322de3-0d81-4ab6-9526-d291d88c335b
Pratap, J.N.
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Vettukattil, J.J.
278da137-966f-4a72-b0a1-1e8225620fd6
Veldtman, G.
17aa0d1b-f2ce-4009-af73-049cde18d676
Navaratnam, D.
22c1ff56-3b8a-4acb-b6af-dc5f2d8941c4
Fitzsimmons, S.
d67fd486-0e47-4432-a0ed-3a42ab30f967
Grocott, M.
1e87b741-513e-4a22-be13-0f7bb344e8c2
Rossiter, H.B.
b290e978-2000-44d2-a7fd-09f3725ab50c
Emmanuel, Y.
f0961720-4610-409d-b347-b47328c9d6bb
Diller, G.P.
c8a575ad-67f9-4148-97ac-87c204bf242b
Gordon-Walker, T.
85cec5fd-0794-4e1b-bba6-b14a5ddaad80
Jack, S.
d824ec2e-e92f-4e68-8fa5-953dfec46208
Sheron, N.
cbf852e3-cfaa-43b2-ab99-a954d96069f1
Pappachan, J.
f5322de3-0d81-4ab6-9526-d291d88c335b
Pratap, J.N.
3386a996-491c-4d3d-a56c-6665e15fcbca
Vettukattil, J.J.
278da137-966f-4a72-b0a1-1e8225620fd6
Veldtman, G.
17aa0d1b-f2ce-4009-af73-049cde18d676

Navaratnam, D., Fitzsimmons, S., Grocott, M., Rossiter, H.B., Emmanuel, Y., Diller, G.P., Gordon-Walker, T., Jack, S., Sheron, N., Pappachan, J., Pratap, J.N., Vettukattil, J.J. and Veldtman, G. (2016) Exercise-induced systemic venous hypertension in the Fontan circulation The American Journal of Cardiology, 117, (10), pp. 1167-1671. (doi:10.1016/j.amjcard.2016.02.042). (PMID:27032711).

Record type: Article

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.

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More information

Accepted/In Press date: 18 February 2016
e-pub ahead of print date: 3 March 2016
Published date: 15 May 2016
Organisations: Clinical & Experimental Sciences

Identifiers

Local EPrints ID: 393680
URI: http://eprints.soton.ac.uk/id/eprint/393680
ISSN: 0002-9149
PURE UUID: b40e38e0-3042-4e26-bcb2-3566d2e4cf20
ORCID for N. Sheron: ORCID iD orcid.org/0000-0001-5232-8292

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Date deposited: 03 May 2016 08:53
Last modified: 17 Jul 2017 19:06

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Contributors

Author: D. Navaratnam
Author: S. Fitzsimmons
Author: M. Grocott
Author: H.B. Rossiter
Author: Y. Emmanuel
Author: G.P. Diller
Author: T. Gordon-Walker
Author: S. Jack
Author: N. Sheron ORCID iD
Author: J. Pappachan
Author: J.N. Pratap
Author: J.J. Vettukattil
Author: G. Veldtman

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