Predicting the effects of surgically determined parameters on exercise tolerance in Fontan patients

The Fontan physiology is a surgically created circulation for patients with a single functioning ventricle. Patients with this circulation tend to have lower exercise tolerance compared to those with a normal circulation. Important computational and experimental work has been done to investigate this reduction in exercise tolerance. However, there are few systematic modeling studies that focus on the effect of several surgically determined parameters within the same framework. We propose a mathematical model to describe the Fontan circulation under exercise. We then formulate a heuristic based on clinical data from Fontan patients to estimate exercise tolerance. The model is used to investigate the effect of three important surgically determined parameters on exercise tolerance: the systemic arterial compliance , the systemic-venous to pulmonary-venous fenestration, and the resistance of the total cavopulmonary connection . • Compartmental models can be calibrated to capture Fontan hemodynamics in exercise. • A larger systemic arterial compliance leads to lower exercise tolerance. • Small fenestrations have little impact on exercise tolerance. • High resistance total cavopulmonary connections are detrimental to exercise tolerance.