Congenital Heart Disease, Single-ventricle
Conditions
Keywords
Fontan
Brief summary
The purpose of the proposed study is to determine the safety of enhanced external counterpulsation (EECP), a system for compressing the blood vessels in the legs in synchrony with an individual's cardiac rhythm, in clinically well, adult Fontan patients, to document the acute hemodynamic and myocardial effects of EECP on the Fontan circulation, and to demonstrate acute changes in endothelial function after one hour of the procedure.
Detailed description
The investigators plan to study the effects of enhanced external counterpulsation (EECP), on patients who have had Fontan surgery for treatment of complex congenital heart disease. Eligible patient volunteers will undergo a series of biophysical measurements at rest including echocardiographic assessment of ventricular function, pulmonary blood flow/cardiac output measurement using an inert gas rebreathing method (Innocor), and measurements of biomarkers of endothelial function (ET-1, NOx). Patients will then undergo 1 hour of treatment with EECP, during which additional echocardiographic assessment of ventricular function and pulmonary blood flow/cardiac output measurements will be performed at multiple levels of leg compression. Subjects will be assessed periodically for adverse effects and discomfort during the EECP treatment. At the completion of treatment, patients will be allowed 30 minutes to rest before undergoing one more echocardiographic assessment of ventricular function, pulmonary blood flow/cardiac output measurement, and measurements of biomarkers of endothelial function (ET-1, NOx). Measurements made during and after treatment will be compared to baseline measurements.
Interventions
DEVICEEECP
1 hour of treatment with EECP
Sponsors
Boston Children's Hospital
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Individuals with Fontan physiology being seen in the Boston Children's Hospital cardiology clinic for outpatient care.
Exclusion criteria
* Current pregnancy * Decompensated heart failure/pulmonary edema * Severe aortic insufficiency * Active tachyarrhythmias * Frequent atrial or ventricular ectopy * Symptomatic peripheral vascular disease * Thrombophlebitis or history of deep vein thrombosis or stasis ulcer * Aortic aneurysm * Uncontrolled hypertension (systolic blood pressure \>180 mmHg or diastolic blood pressure\>110 mmHg) * Systolic blood pressure \<90 mmHg * Active femoral site bleeding or hematoma
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in cardiac output | Immediately prior to starting EECP treatment, during each 20-minute phase of EECP treatment, and 30 minutes after EECP treatment | Measurement of cardiac output (pulmonary blood flow) in L/min using inert gas rebreathing method (Innocor CO device) |
| Total number and type of adverse events during EECP treatment | During EECP treatment (duration 60 minutes) | Adverse events will be collected by an investigator and documented using CTCAE criteria |
| Total number and type of adverse events immediately following EECP treatment | From completion of EECP treatment until patient discharge (30 to 60 minutes) | Adverse events will be collected by an investigator and documented using CTCAE criteria |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in ventricular strain analysis | Immediately prior to starting EECP treatment, during each 20-minute phase of EECP treatment, and 30 minutes after EECP treatment | Global mid-ventricle circumferential strain (%) and global longitudinal strain (%) calculated from speckle-tracking echocardiography |
| Total nitrate/nitrite (NOx) levels | pre and 30 minutes post EECP treatment | This will measure endothelial function |
| Change in qualitative ventricular systolic function | Immediately prior to starting EECP treatment, during each 20-minute phase of EECP treatment, and 30 minutes after EECP treatment | Qualitative assessment of systolic function of dominant ventricle on 2-dimensional echocardiography, categorized as normal, low normal to mildly depressed, mildly depressed, mildly to moderately depressed, moderately depressed, moderately to severely depressed, severely depressed, or unable to determine. |
| plasma endothelin (ET-1) | pre and 30 minutes post EECP treatment | This will measure endothelial function |
Countries
United States
Outcome results
None listed