Lymphatic function in patients with Fontan circulation: effect of physical training

Abstract

The Fontan operation is the procedure of choice for patients born with complex congenital heart defects with a single anatomical or functional ventricle. Unfortunately, there are numerous short- and long-term complications associated with Fontan circulation, including lymphatic insufficiency, a greater predisposition to develop interstitial edema, and a decrease in physical capacity. Objective: To identify the functional status of lymphatic vessels with images obtained by the infrared fluorescence technique (Near Infrared Fluorescence Imaging) in patients after the Fontan surgery; Assess maximum and submaximal functional capacity; to verify the effect of physical training on the lymphatic system, functional capacity and quality of life in patients with Fontan circulation. Methodology: Longitudinal study, controlled clinical trial, where 20 patients will be evaluated and allocated into 2 groups: Physical Training Group - GTF (aerobic exercise + localized muscular resistance exercise) and Non-Physical Training Group - GNTF. After a period of 36 training sessions, the GNTF was maintained in its usual routine, the patients, as well as the controls, will be reassessed. The lymphatic system will be evaluated from a functional point of view by the infrared fluorescence technique. The maximum functional capacity by cardiopulmonary exercise test and submaximal by the 6-minute walk test. The humoral assessment will be done by means of peripheral venous blood collection, where the plasma dosage of norepinephrine and brain natriuretic peptide BNP. The data for analysis of heart rate variability will be collected during the 6-minute walk test, using the Polar RS800 frequency meter and quality of life through the SF-36 questionnaire. To identify the level of physical activity, the Physical Activity Inventory - IPAQ will be applied Short Version. Expected results: To identify the components responsible for the impairment of the peripheral lymphatic system, it is expected to evaluate the impact of physical training, and how much it can improve lymphatic vessel function, inflammatory and neurohumoral markers, muscle blood flow, functional capacity and quality of life. life of the GTF compared to the GNTF. (AU)