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Cardiovascular, pulmonary and skeletal muscle evaluation in patients with univentricular physiology in the late postoperative period of the Fontan surgery: effects of exercise training

Abstract

Introduction: Different variations of the Fontan operation has been used to treat complex cardiac anomalies with a single functional ventricle. This procedure has substantially improved quality of life and survival in patients with these complex cardiac anomalies. However, the cardiovascular and pulmonary functioning as well as skeletal muscle alterations that can explain the exercise intolerance in these patients is still poorly understood. Objective: 1) To investigate the global clinical status including cardiovascular, pulmonary and muscle skeletal system in patients undergoing the Fontan surgery and 2) To study the effects of exercise training, respiratory training or the combination of both on cardiovascular, pulmonary responses and muscle skeletal system in these patients. Methods: The study will be divided into two phases. A) a cross-sectional, case-control study that will include patients between 12 and 30 years, submitted to total cavopulmonary connection for at least 5 years post operatively at the Heart Institute, University of São Paulo Medical. B) a long-term randomized clinical study, in which 60 patients will be divided into four groups: 1) Exercise training with aerobic exercise + lower and upper limb strenght exercise (GTF-I); 2) Respiratory training with respiratory muscle exercise (GTF-II); 3) Exercise training with aerobic exercise + lower and upper limb strenght exercise + Respiratory training with respiratory muscle exercise (GTF-III); and A non-exercise group as control group (GNTF-IV). The patients will be reavaluated after the 4-month period of intervention. Expected Outcomes: 1. In the first phase, we expect that our findings will improve the undertanding the exercise intolerance by explaining the cardiovascular, pulmonary and skeletal muscle limitations in patients with univentricular circulation. 2. In the second phase, to demonstrate that exercise training and respiratory training can substantially improve the cardiovascular and pulmonar responses and skeletal muscle system in patients with univentricular circulation. In addition, we wil test the hypothesis that the effects of exercise training associated with respiratory training on cardiovascular and pulmonar responses and skeletal muscle system may be greater than exercise training or respiratory training alone.Keywords: Fontan (AU)

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Scientific publications
(References retrieved automatically from Web of Science and SciELO through information on FAPESP grants and their corresponding numbers as mentioned in the publications by the authors)
RIBEIRO TURQUETTO, AIDA LUIZA; DOS SANTOS, MARCELO RODRIGUES; AGOSTINHO, DANIELA REGINA; CARRARI SAYEGH, ANA LUIZA; DE SOUZA, FRANCIS RIBEIRO; AMATO, LUCIANA PATRICK; RU BARNABE, MILENA SCHIEZARI; DE OLIVEIRA, PATRICIA ALVES; LIBERATO, GABRIELA; BINOTTO, MARIA ANGELICA; NEGRAO, CARLOS EDUARDO; CANEO, LUIZ FERNANDO; TRINDADE, EVELINDA; JATENE, FABIO BISCEGLI; JATENE, MARCELO BISCEGLI. Aerobic exercise and inspiratory muscle training increase functional capacity in patients with univentricular physiology after Fontan operation: A randomized controlled trial. INTERNATIONAL JOURNAL OF CARDIOLOGY, v. 330, p. 50-58, MAY 1 2021. Web of Science Citations: 0.
RIBEIRO TURQUETTO, AIDA LUIZA; DOS SANTOS, MARCELO RODRIGUES; CARRARI SAYEGH, ANA LUIZA; DE SOUZA, FRANCIS RIBEIRO; AGOSTINHO, DANIELA REGINA; DE OLIVEIRA, PATRICIA ALVES; DOS SANTOS, YARLA ALVES; LIBERATO, GABRIELA; BINOTTO, MARIA ANGELICA; GARCIA OTADUY, MARIA CONCEPCION; NEGRAO, CARLOS EDUARDO; CANEO, LUIZ FERNANDO; JATENE, FABIO BISCEGLI; JATENE, MARCELO BISCEGLI. Blunted peripheral blood supply and underdeveloped skeletal muscle in Fontan patients: The impact on functional capacity. INTERNATIONAL JOURNAL OF CARDIOLOGY, v. 271, p. 54-59, NOV 15 2018. Web of Science Citations: 4.
TURQUETTO, AIDA L. R.; CANEO, LUIZ F.; AGOSTINHO, DANIELA R.; OLIVEIRA, PATRICIA A.; LOPES, MARIA ISABEL C. S.; TREVIZAN, PATRICIA F.; FERNANDES, FREDERICO L. A.; BINOTTO, MARIA A.; LIBERATO, GABRIELA; TAVARES, GLAUCIA M. P.; NEIROTTI, RODOLFO A.; JATENE, MARCELO B. Impaired Pulmonary Function is an Additional Potential Mechanism for the Reduction of Functional Capacity in Clinically Stable Fontan Patients. PEDIATRIC CARDIOLOGY, v. 38, n. 5, p. 981-990, JUN 2017. Web of Science Citations: 11.

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