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Calf Muscle Oxygenation is Impaired and May Decline with Age in Young Patients with Total Cavopulmonary Connection

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Abstract

Patients palliated with Total Cavopulmonary Connection have a lower muscle mass and a lower exercise capacity. We assessed calf muscle oxidative metabolism during and after heel raise exercise to exhaustion in young patients with TCPC compared to healthy peers. Near-infrared spectroscopy was used for measuring oxygen metabolism in the medial portion of the gastrocnemius muscle. Forty-three patients with TCPC, aged 6–18 years, were compared with 43 age and sex-matched healthy control subjects. Subgroups were formed to include children (6–12 years) and adolescents (13–18 years) to determine if these age groups influenced the results. During exercise, for the patients compared to controls there was a lower increase in deoxygenated hemoglobin (oxygen extraction) (5.13 ± 2.99au vs. 7.75 ± 4.15au, p = 0.001) and a slower rate of change in total hemoglobin (blood volume) (0.004 ± 0.015au vs 0.016 ± 0.01au, p = 0.001). Following exercise, patients exhibited a slower initial increase in tissue oxygenation saturation index (0.144 ± 0.11au vs 0.249 ± 0.226au, p = 0.007) and a longer half-time to maximum hyperemia (23.7 ± 11.4 s vs 16.8 ± 7.5 s, p = 0.001). On the subgroup level, the adolescents differed compared to healthy peers, whereas the children did not. Young patients with TCPC had impaired oxidative metabolism during exercise and required a longer time to recover. In that the differences were seen in the adolescent group and not in the children group may indicate a declining function with age.

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Funding

Financial support was provided through the Swedish Heart–Lung Foundation (20160496) and the Swedish Odd Fellow Order.

Author information

Author notes

  1. Annika Rydberg and Camilla Sandberg contributed equally to the last authorship.

Authors and Affiliations

  1. Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden

    Magne Sthen Bergdahl & Annika Rydberg

  2. Centre for Musculoskeletal Research, Department of Occupational and Public Health Sciences and Psychology, University of Gävle, Gävle, Sweden

    Albert G. Crenshaw

  3. Department of Women’s and Children’s Health, Division of Pediatric Cardiology, Karolinska Institutet, Stockholm, Sweden

    Eva Rylander Hedlund & Gunnar Sjöberg

  4. Department of Public Health and Clinical Medicine, Medicine, Umeå University, Umeå, Sweden

    Camilla Sandberg

  5. Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden

    Camilla Sandberg

  6. Centre for Pediatrics and Adolescent Medicine, Norrlands University Hospital, 90737, Umeå, Sweden

    Magne Sthen Bergdahl

Authors
  1. Magne Sthen Bergdahl
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  2. Albert G. Crenshaw
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Contributions

All authors contributed to the study conception and design. Participant invitation and informed consent gathering were performed by Magne Sthen Bergdahl and Camilla Sandberg. Data collection was mainly done by Camilla Sandberg and Albert Crenshaw. Data analysis were performed by Magne Sthen Bergdahl and Albert Crenshaw. The first draft of the manuscript was written by Magne Sthen Bergdahl and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Magne Sthen Bergdahl.

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The authors declare that they have no conflict of interest.

Ethical Approval

The study was approved by the Regional Ethical Review Board in Umeå, Sweden (Dnr: 2016-445-31 M).

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Prior to the study, caregivers provided informed written consent for the subjects younger than 18 years and those who were 18 years gave consent themselves.

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Bergdahl, M.S., Crenshaw, A.G., Hedlund, E.R. et al. Calf Muscle Oxygenation is Impaired and May Decline with Age in Young Patients with Total Cavopulmonary Connection. Pediatr Cardiol 43, 449–456 (2022). https://doi.org/10.1007/s00246-021-02743-6

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  • DOI: https://doi.org/10.1007/s00246-021-02743-6

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