Document Detail

How good is a good Fontan? Quality of life and exercise capacity of Fontans without arrhythmias.
MedLine Citation:
PMID:  19932269     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Poor long-term outcomes are expected after Fontan surgery, but these perspectives have been tainted by the poorly functioning Fontans suffering from arrhythmias. No predictions of outcome can be quoted to the increasing number of Fontan patients free from arrhythmic complications. The parameters determining improved exercise capacity and quality of life in this subgroup are yet unknown. METHODS: Fontan survivors from our institution and living in Victoria were invited to participate in the study if they were more than 10 years of age, and free of arrhythmias. A mean of 17 +/- 4 years after Fontan, 36 patients, 23 with a classical atriopulmonary connection (AP) and 13 with a lateral tunnel (LT) underwent transthoracic echocardiography, cycloergometer exercise study, neurohumoral screening, and assessment of quality of life. RESULTS: The only factor predicting worse exercise capacity was the type of Fontan performed; patients with LT having better exercise capacity than those with AP (percentage of predicted anaerobic threshold: 88 +/- 14% vs 72 +/- 14%, p < 0.005; percentage of predicted VO(2)max: 62 +/- 8% vs 54 +/- 7%, p < 0.005). Endothelin-1 levels were elevated in all patients (2.9 pmol/L, 2.5 to 3.7). Responses from the quality of life measures placed our Fontan cohort mainly within the normal population range. None of the preoperative and postoperative variables adversely affected patients' quality of life. CONCLUSIONS: The anaerobic threshold of arrhythmia-free Fontan patients operated with the lateral tunnel technique was relatively preserved. Despite restricted exercise capacity, Fontan patients, provided that they are free of arrhythmias, have a normal quality of life reflected in their reports of psychiatric symptoms and family relationships.
Yves d'Udekem; Michael M H Cheung; Stella Setyapranata; Ajay J Iyengar; Patricia Kelly; Naomi Buckland; Leeanne E Grigg; Robert G Weintraub; Alasdair Vance; Christian P Brizard; Dan J Penny
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  88     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2009 Dec 
Date Detail:
Created Date:  2009-11-25     Completed Date:  2010-01-05     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  1961-9     Citation Subset:  AIM; IM    
Department of Cardiac Surgery, Royal Children's Hospital, Parkville, Victoria, Australia.
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MeSH Terms
Arrhythmias, Cardiac / epidemiology*
Child, Preschool
Disease-Free Survival
Exercise Tolerance / physiology*
Follow-Up Studies
Fontan Procedure*
Heart Defects, Congenital / mortality,  surgery*
Postoperative Period
Quality of Life*
Retrospective Studies
Time Factors
Treatment Outcome
Victoria / epidemiology
Young Adult

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