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Müller N, Herberg U, Breuer J, Kratz T, Härtel JA. Fitness to fly for children and adolescents after Fontan palliation. Front Cardiovasc Med 2023; 10:1170275. [PMID: 37424899 PMCID: PMC10326614 DOI: 10.3389/fcvm.2023.1170275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 06/02/2023] [Indexed: 07/11/2023] Open
Abstract
Introduction At cruising altitude, the cabin pressure of passenger aircraft needs to be adjusted and, therefore, the oxygen content is equivalent to ambient air at 2,500 masl, causing mild desaturation and a rising pulmonary vascular resistance (PVR) in healthy subjects. For Fontan patients with passive pulmonary perfusion, a rising PVR can cause serious medical problems. The purpose of this fitness to fly investigation (FTF) is to assess the risk of air travel for children and adolescents after Fontan palliation. Methods We investigated 21 Fontan patients [3-14y] in a normobaric hypoxic chamber at a simulated altitude of 2,500 m for 3 h. Oxygen saturation, heart rate, and regional tissue saturation in the forehead (NIRS) were measured continuously. Before entering the chamber, after 90 and 180 min in the hypoxic environment, blood gas analysis and echocardiography were performed. Results Heart rate and blood pressure did not show significant intraindividual changes. Capillary oxygen saturation (SaO2) decreased significantly after 90 min by a mean of 5.6 ± 2.87% without further decline. Lactate, pH, base excess, and tissue saturation in the frontal brain did not reach any critical values. In the case of open fenestration between the tunnel and the atrium delta, P did not increase, indicating stable pulmonary artery pressure. Conclusion All 21 children finished the investigation successfully without any adverse events, so flying short distance seems to be safe for most Fontan patients with good current health status. As the baseline oxygen saturation does not allow prediction of the maximum extent of desaturation and adaption to a hypoxic environment takes up to 180 min, the so-called hypoxic challenge test is not sufficient for these patients. Performing an FTF examination over a period of 180 min allows for risk assessment and provides safety to the patients and their families, as well as the airline companies.
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Affiliation(s)
- N. Müller
- Department for Pediatric Cardiology, Children’s Heart Center UK Bonn, University Hospital Bonn, Bonn, Germany
| | - U. Herberg
- Department for Pediatric Cardiology, Children’s Heart Center UK Bonn, University Hospital Bonn, Bonn, Germany
- Department for Pediatric Cardiology, University Hospital Aachen, Aachen, Germany
| | - J. Breuer
- Department for Pediatric Cardiology, Children’s Heart Center UK Bonn, University Hospital Bonn, Bonn, Germany
| | - T. Kratz
- Department for Pediatric Cardiology, Children’s Heart Center UK Bonn, University Hospital Bonn, Bonn, Germany
| | - J. A. Härtel
- Department for Pediatric Cardiology, Children’s Heart Center UK Bonn, University Hospital Bonn, Bonn, Germany
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Coker RK, Armstrong A, Church AC, Holmes S, Naylor J, Pike K, Saunders P, Spurling KJ, Vaughn P. BTS Clinical Statement on air travel for passengers with respiratory disease. Thorax 2022; 77:329-350. [PMID: 35228307 PMCID: PMC8938676 DOI: 10.1136/thoraxjnl-2021-218110] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Robina Kate Coker
- Respiratory Medicine, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Alison Armstrong
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | | | | | - Katharine Pike
- Department of Paediatric Respiratory Medicine, Bristol Royal Hospital for Children, Bristol, UK
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Yang WJ, Chen IW, Lu WH. International commercial air transport of the child with severe cyanotic congenital heart disease. J Paediatr Child Health 2022; 58:175-178. [PMID: 33655580 DOI: 10.1111/jpc.15424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 02/10/2021] [Accepted: 02/15/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Wan-Jung Yang
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - I-Wen Chen
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Wen-Hsien Lu
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Herberg U, Knies R, Müller N, Breuer J. Altitude exposure in pediatric pulmonary hypertension-are we ready for (flight) recommendations? Cardiovasc Diagn Ther 2021; 11:1122-1136. [PMID: 34527538 DOI: 10.21037/cdt-20-494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 08/27/2020] [Indexed: 11/06/2022]
Abstract
Patients with congenital heart disease are surviving further into adulthood and want to participate in multiple activities. This includes exposure to high altitude by air travel or recreational activities, such as hiking and skiing. However, at an altitude of about 2,500 m, the barometric environmental pressure is reduced and the partial pressure of inspired oxygen drops from 21% to 15% (hypobaric hypoxia). In physiologic response to high-altitude-related hypoxia, pulmonary vasoconstriction is induced within minutes of exposure followed by compensatory hyperventilation and increased cardiac output. Even in healthy children and adults, desaturation can be profound and lead to a significant rise in pulmonary pressure and resistance. Individuals with already increased pulmonary pressure may be placed at risk during high-altitude exposure, as compensatory mechanisms may be limited. Little is known about the physiological response and risk of developing clinically relevant events on altitude exposure in pediatric pulmonary hypertension (PAH). Current guidelines are, in the absence of clinical studies, mainly based on expert opinion. Today, healthcare professionals are increasingly faced with the question, how best to assess and advise on the safety of individuals with PAH planning air travel or an excursion to mountain areas. To fill the gap, this article summarises the current clinical knowledge on moderate to high altitude exposure in patients with different forms of pediatric PAH.
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Affiliation(s)
- Ulrike Herberg
- Department of Pediatric Cardiology, University Hospital Bonn, Bonn, Germany
| | - Ralf Knies
- Department of Pediatric Cardiology, University Hospital Bonn, Bonn, Germany
| | - Nicole Müller
- Department of Pediatric Cardiology, University Hospital Bonn, Bonn, Germany
| | - Johannes Breuer
- Department of Pediatric Cardiology, University Hospital Bonn, Bonn, Germany
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Taçoy G. Congenital heart disease and air travel. Anatol J Cardiol 2021; 25:18-19. [PMID: 34464294 DOI: 10.5152/anatoljcardiol.2021.s107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The number of individuals traveling by airplanes is increasing every year. Patients with congenital heart disease and shunts, exposure to high altitude during a flight is important since it causes pulmonary vaso- constriction leading to an increase in right-to-left shunting and a decrease in arterial oxygen saturation. Patients with cyanotic congenital heart disease and Eisenmenger syndrome should be evaluated before the flight, and necessary precautions should be taken.
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Affiliation(s)
- Gülten Taçoy
- Department of Cardiology, Faculty of Medicine, Gazi University; Ankara-Turkey
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Souza NMGD, Silva VMD, Lopes MVDO, Guedes NG, Pascoal LM, Beltrão BA. Content validity of the nursing diagnostic Breathing Pattern, Ineffective, in children with congenital heart defects. Rev Bras Enferm 2021; 74:e20190844. [PMID: 33909807 DOI: 10.1590/0034-7167-2019-0844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 11/01/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To estimate the content validity of the nursing diagnostic Breathing Pattern, Ineffective, in children with congenital heart defects. METHOD Methodological study in two stages: 1) integrative literature review; 2) content validation, with 23 nurses. An instrument with 10 related factors and 21 defining characteristics for data collection was used. The analysis by the evaluators was carried out using the relevance criteria. The Content Validity Index was used. Valid results were those above 0.9 with a Wilcoxon test above 0.05. RESULTS The final proposal incorporates nine from the ten causal factors. From them, five do not belong in the NANDA-I list. Regarding the defining characteristics, they were all considered to be relevant, and five are not among the list of signs and symptoms of the NANDA-I taxonomy. CONCLUSION The findings of this study include specific elements of the pediatric population with congenital heart defect which are not present in the structure of the diagnostic being studied.
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Affiliation(s)
| | | | | | | | | | - Beatriz Amorim Beltrão
- Universidade Federal do Ceará, Hospital Universitário Walter Cantídio. Fortaleza, Ceará, Brazil
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Morimoto Y, Ohuchi H, Kurosaki K, Nakai M. Exercise-induced hypoxia predicts hypobaric hypoxia during flight in patients after Fontan operation. Int J Cardiol 2020; 325:51-55. [PMID: 33010380 DOI: 10.1016/j.ijcard.2020.09.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 08/19/2020] [Accepted: 09/29/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Hypobaric hypoxia (HH) during flight might be more detrimental to pulmonary circulation in Fontan patients compared healthy individuals. This study was designed to clarify whether exercise-induced hypoxia could predict HH during flight in Fontan patients. METHODS AND RESULTS Percutaneous oxygen saturation (SpO2) was analyzed during flight in 11 Fontan patients and eight volunteers. SpO2 was measured before taking off (S1), at the initial (S2), the end of stabilization (S3), and after landing (S4). The SpO2-dynamics were compared with SpO2-dynamics during cardiopulmonary exercise testing (CPX), pulmonary function, and hemodynamics in the Fontan patients. At all measurements, SpO2 was lower in the Fontan patients than the volunteers during flight. The total SpO2 decline from S1 to S3 was greater in the Fontan patients than the volunteers. While SpO2 change from S2 to S3 was negative in the Fontan patients, it was stable in the volunteers. In the Fontan patients, the median value of exercise-induced SpO2 decline (Ex-dSpO2), SpO2 at rest, and SpO2 at peak was -6%, 93%, and 88%, respectively. In addition to exercise capacity and pulmonary function, the Ex-dSpO2 was correlated strongly with SpO2 at all phases during flight (r = 0.75-0.98, p < 0.01 for all). Flight-associated adverse events occurred in two patients with SpO2 < 80% at S3. CONCLUSIONS Both the Fontan patients and the volunteers demonstrated similar SpO2-dynamics during flight with a greater HH in the Fontan patients. CPX with SpO2 monitoring is useful in predicting SpO2-dynamics and adverse events during flight in these patients.
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Affiliation(s)
- Yoshihito Morimoto
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan; Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Hideo Ohuchi
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
| | - Kenichi Kurosaki
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Michikazu Nakai
- Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
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Härtel JA, Müller N, Herberg U, Breuer J, Bizjak DA, Bloch W, Grau M. Altered Hemorheology in Fontan Patients in Normoxia and After Acute Hypoxic Exercise. Front Physiol 2019; 10:1443. [PMID: 31824342 PMCID: PMC6883377 DOI: 10.3389/fphys.2019.01443] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 11/08/2019] [Indexed: 12/02/2022] Open
Abstract
Background The Fontan circulation is a unique palliation procedure for several congenital heart defects. Impaired exercise capacity has previously been demonstrated in these patients and also a higher risk for cardiopulmonary mortality. Hemorheology was shown to affect cardiopulmonary capacity and in turn to be affected by regular exercise and hypoxia but none of these have been investigated in Fontan patients so far. The aim of this study was to detect general differences in hemorheology in normoxia as well as possible altered hemorheological responses to hypoxia exposure and hypoxic exercise between Fontan patients and healthy controls. Methods and Findings 26 Fontan patients and 20 healthy controls performed an acute exercise test (AET) on a bicycle ergometer under hypoxia with ambient 15.2% oxygen saturation (sO2). Blood samples were taken at rest in normoxia (T0), at rest in hypoxia (T1), after maximum exhaustion in hypoxia (T2), and after 50 min recovery in normoxia (T3). Hemorheological and blood parameters were investigated. Additionally, arterial stiffness was tested at T0. Red blood cell (RBC) deformability, NOx, erythropoietin (EPO) concentration, RBC count, hemoglobin (Hb) concentration and hematocrit (hct) were significantly increased in Fontan patients compared to controls. Same was observed for arterial stiffness. No changes were observed for RBC aggregation, fibrinogen concentration, free radical levels and vascular endothelial growth factor (VEGF). Hypoxia exposure did not change parameters, whereas exercise in hypoxia increased aggregation and hct significantly in both groups. Fontan patients showed significantly increased aggregation-disaggregation balance compared to controls. Conclusion Acute hypoxia exposure and exercise under hypoxia might have similar impact on hemorheology in Fontan patients and controls and was clinically well tolerated. Nevertheless, exercise alters aggregation and possibly hemodynamics which requires special attention in Fontan patients.
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Affiliation(s)
- Julian Alexander Härtel
- Department of Molecular and Cellular Sports Medicine, German Sport University Cologne, Cologne, Germany.,Department for Pediatric Cardiology, University Hospital Bonn, Bonn, Germany
| | - Nicole Müller
- Department for Pediatric Cardiology, University Hospital Bonn, Bonn, Germany
| | - Ulrike Herberg
- Department for Pediatric Cardiology, University Hospital Bonn, Bonn, Germany
| | - Johannes Breuer
- Department for Pediatric Cardiology, University Hospital Bonn, Bonn, Germany
| | - Daniel Alexander Bizjak
- Department of Molecular and Cellular Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Wilhelm Bloch
- Department of Molecular and Cellular Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Marijke Grau
- Department of Molecular and Cellular Sports Medicine, German Sport University Cologne, Cologne, Germany
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Files MD, Deen JF. Off we go into the wild blue yonder: preflight hypoxic testing in patients with congenital heart disease. BRITISH HEART JOURNAL 2018; 104:1313-1314. [DOI: 10.1136/heartjnl-2018-312995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Ribeiro AL, Otto CM. Heartbeat: Do public access defibrillators save lives? BRITISH HEART JOURNAL 2018; 104:1309-1310. [DOI: 10.1136/heartjnl-2018-313782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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