Pediatric Heart Expert Forum
fontan surgery
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fontan surgery

my dughter 9 years of old, underwent intracardiac fontan surgery 3 years back for DOV, ASD, VSD. Doing well on aspirin 75 mg. Heart rate is in the lower side. 3 months back holter done, lowest was 35 in the early morning. day time 50-60 or 65. Physicaly alright, no dizzi or weekness. Is she alright now, does it give any problem for the future. Could please give a detailed replay.

Thank you very much
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773637_tn?1327450515
Dear Howwa,

Allow me to explain a few things to our other readers.  The Fontan palliation is a surgical procedure performed on patients who have only one ventricle that allows that one ventricle to pump blood out to the body while blood returning from the body passively flows into the lungs (with help from a little suction from the single ventricle).  One of the common complications that we see in these patients is sinus node dysfunction, or abnormal function of the natural pacemaker of the heart.  This is due to the large amount of surgery and scar tissue near the sinus node, which can certainly occur with an intracardiac version of the Fontan.  Therefore, it is not uncommon to see heart rates this low in patients after a Fontan.  

At this point, the most important fact is that she is asymptomatic.  However, my guess is that with significant exercise, she is probably not able to get her heart rate up adequately like her peers, and probably has some aspect of exercise intolerance.  This is probably not a serious concern now, although it can be problematic in the future, especially in situations in which she needs to be able to get her heart rate up.  Examples of these situations include during a febrile illness or if her ventricular function happens to decline over time, which can certainly happen in these patients, depending on their original cardiac anatomy.  I am not exactly sure from your description what her initial anatomy and function was, so I can’t predict how this will be in the future.  There are recommended published criteria for patients with sinus node dysfunction to have a pacemaker placed.  Typically, your cardiologist will be keeping track of her and, if she starts showing signs of her heart rate being too slow for her needs, will consider this as an option.
3 Comments
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My son has hada both the Glenn and Fontain Surgery.  He has a single ventrical, double outlet, malpositon of the great arteries.  (I hope I am spelling these things correclty.)  He has been **** wonderful except now that he is 7 cardioloist did a sonogram and he had a low pressure of 45.  It used to be 50.  He redid the test and says it was l little better but we need to keep our eyes on it since if it keeps decining he may need a pace maker.  My son is very active and keeps up with his younger sibling.  He runs without showing signs of getting tired ever.  Can walking with me in the afternoon help him.  Of cource not more than I see he wants and is able to do.  But can walking help the heart get stronger or are there risks.  Can exercise hurt him.  How much is good?  Can excersise help?
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773637_tn?1327450515
Dear XSuarez,

No matter what the heart condition, we are realizing more and more that aerobic exercise is helpful for the heart.  This would include walking, running, bicycling, swimming, basketball, etc.  It improves what we call the "myocardial reserve", which means that it conditions the heart to be a stronger muscle that is able to function better in times of stress.  Certainly, a 7 year old will be very good at self-limiting his activities, so I am not worried about him overdoing it at this point.  I'm not sure I understand what you mean about him having a "low pressure" of 45 based on his echocardiogram.  Are you sure that's not his heart rate?  If it is his heart rate, then I understand what your doctor meant when he felt that your son might eventually require a pacemaker at some time in the future.

Overall, I would let him self-limit his exercise and not limit him yourself.  The American Heart Association recommendations are for aerobic exercise on a daily basis for at least 60 minutes.  I would say that if he is able to do that, he is doing relatively well at this point.
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A related discussion, After the fontan ... what to look for was started.
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773637_tn?1327450515
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The Children’s Hospital of Philadelphia
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