Severely impaired cardiac autonomic nervous activity after the Fontan operation

Citation
H. Ohuchi et al., Severely impaired cardiac autonomic nervous activity after the Fontan operation, CIRCULATION, 104(13), 2001, pp. 1513-1518
Citations number
30
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Journal title
CIRCULATION
ISSN journal
0009-7322 → ACNP
Volume
104
Issue
13
Year of publication
2001
Pages
1513 - 1518
Database
ISI
SICI code
0009-7322(20010925)104:13<1513:SICANA>2.0.ZU;2-L
Abstract
Background-Elevated neurohumoral activity and an abnormal cardiopulmonary r esponse to exercise are well-established characteristics in patients after the Fontan operation. However, there have been few studies addressing cardi ac autonomic nervous activity (CANA) in these patients. Methods and Results-We evaluated CANA in 63 post-Fontan patients and 44 con trols. Cardiac parasympathetic nervous activity (PSNA) was estimated by hea rt rate (HR) changes after cholinergic blockade, HR variability, and arteri al baroreflex sensitivity. Cardiac sympathetic nervous activity was estimat ed by the heart to mediastinum. [I-123]metaiodobenzylguanidine activity rat io (HIM) and the HR increase (Delta HR) after isoproterenol infusion (beta) . Delta HR and peak oxygen uptake ((V) over dot O-2) were measured by exerc ise test. There was no difference in beta between the Fontan group and cont rols. PSNA and H/M were markedly lower than in controls (P <0.001). PSNA an d beta were related to Delta HR (P <0.05); however, peak (V) over dot O-2 w as not correlated with Delta HR. Neither PSNA nor H/M was associated with c linical features, including hemodynamics, type of repair, number of surgica l procedures, age at Fontan operation, or follow-up period, and administrat ion of an angiotensin-converting enzyme inhibitor did not improve the impai red CANA in these patients. Conclusions-After the Fontan procedure, postsynaptic P-sensitivity is maint ained and is important in Delta HR during exercise as is PSNA, although Del ta HR does not determine exercise capacity. The lack of a relationship betw een CANA and clinical features implies that, in addition to surgical damage , the Fontan circulation per se may impair CANA. Angiotensin-converting enz yme inhibitor administration does not change this abnormality.