Abstract
Background
Protein-losing enteropathy (PLE) is a severe complication of Fontan circulation with increased risk of end-organ dysfunction. We evaluated tissue oxygenation via near-infrared spectroscopy (NIRS) at different exercise levels in Fontan patients.
Methods
Assessment of multisite NIRS during cycle ergometer exercise and daily activities in three groups: Fontan patients with PLE; without PLE; patients with dextro-transposition of the great arteries (d-TGA); comparing univentricular with biventricular circulation and Fontan with/without PLE. Renal threshold analysis (<65%;<55%;<45%) of regional oxygen saturation (rSO2) was performed.
Results
Fontan patients showed reduced rSO2 (p < 0.05) in their quadriceps femoris muscle compared with biventricular d-TGA patients at all time points. rSO2 in renal tissue was reduced at baseline (p = 0.002), exercise (p = 0.0062), and daily activities (p = 0.03) in Fontan patients with PLE. Renal threshold analysis identified critically low renal rSO2 (rSO2 < 65%) in Fontan patients with PLE during exercise (95% of monitoring time below threshold) and daily activities (83.7% time below threshold).
Conclusion
Fontan circulation is associated with decreased rSO2 values in skeletal muscle and hypoxemia of renal tissue solely in patients with PLE. Reduced rSO2 already during activities of daily life, might contribute to comorbidities in patients with Fontan circulation, including PLE and renal failure.
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Acknowledgements
This work was supported by the German Heart Foundation and German Society of Pediatric Cardiology (DGPK) through the Gerd-Killian grant. The presented work was performed in fulfillment of the requirements for obtaining the degree “Dr. med” at “Friedrich-Alexander University of Erlangen-Nürnberg (FAU)” of Simon Schröer. This work was performed in close cooperation with the German competence network for congenital heart disease. We thank our biostatistician D. Keller (Statistics and Consultation, Kürnach, Germany) for compiling the statistical analysis of the data and V. Laternser and J. Halbfass for English language editing. The paper was presented as a poster at the Annual Meeting of the Association for European Pediatric and Congenital Cardiology AEPC in Rome 2016.
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J.M. and O.T. designed the study and contributed to the paper. S.D., R.C., H.R.T. and F.B.F. contributed to the design of the study. F.M. and A.R. offered the technical expertise of NIRS measurements. J.M., M.A., S.S. and F.M. collected the data. S.S., F.M. and J.M. analyzed and interpreted the data and drafted the paper. M.R. carried out the laboratory analysis of the data. All participating authors critically revised the paper before submission.
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Schröer, S., Fahlbusch, F.B., Münch, F. et al. Multisite measurement of regional oxygen saturation in Fontan patients with and without protein-losing enteropathy at rest and during exercise. Pediatr Res 85, 777–785 (2019). https://doi.org/10.1038/s41390-019-0346-3
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DOI: https://doi.org/10.1038/s41390-019-0346-3
