Effect of Fontan geometry on exercise haemodynamics and its potential implications

Heart
Elaine TangAjit P Yoganathan

Abstract

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. 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. 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 (VO2) at VAT (r=0.373, p=0.01), VO2 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 VO2 at VAT (r=-0.337, p=0.02...Continue Reading

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Citations

Jan 10, 2018·Journal of Cardiovascular Translational Research·Theodorus M J van BakelC Alberto Figueroa
Oct 10, 2019·Journal of Biomechanical Engineering·David RutkowskiAlejandro Roldan-Alzate
Nov 3, 2017·Annals of Biomedical Engineering·Zhenglun Alan WeiAjit Yoganathan
May 8, 2020·Pediatric Cardiology·Zhenglun Alan WeiMahesh Kappanayil
Nov 17, 2019·Journal of Cardiovascular Translational Research·Zhenglun Alan WeiAjit P Yoganathan
Sep 4, 2020·Asian Cardiovascular & Thoracic Annals·Rabin Gerrah, Stephen J Haller
Jun 27, 2019·Annals of Biomedical Engineering·Zhenglun Alan WeiAjit P Yoganathan
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May 7, 2020·Annals of Biomedical Engineering·Zhenglun WeiAjit P Yoganathan
Apr 6, 2020·Journal of Cardiovascular Translational Research·Akash GuptaEthan Kung
Sep 11, 2020·Journal of Cardiovascular Magnetic Resonance : Official Journal of the Society for Cardiovascular Magnetic Resonance·Thomas P CravenJohn P Greenwood
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