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Does TCPC power loss really affect exercise capacity?
  1. Ethan Kung1,
  2. Alison Marsden2,
  3. Catriona Baker3,
  4. Alessandro Giardini4,
  5. Richard Figliola1,
  6. Tain-Yen Hsia3
  1. 1Department of Mechanical Engineering, Clemson University, Clemson, South Carolina, USA
  2. 2Department of Mechanical Engineering, University of California San Diego, San Diego, California, USA
  3. 3Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children, London, UK
  4. 4Cardiorespiratory Unit, Great Ormond Street Hospital, London, UK
  1. Correspondence to Tain-Yen Hsia, Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children, London WC1N 3JH, UK; hsiat{at}

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To the Editor,

We read with interest the article by Khiabani et al,1 where the authors examine the relationship between power loss in the total cavopulmonary connection (TCPC) and clinical exercise testing. Using an indexed power loss, ‘iPL’, they report that higher iPL correlates with worse minute oxygen consumption and exercise work at anaerobic threshold. Based on this, the authors suggest that power loss in the TCPC could affect exercise performance in a patient with Fontan circulation. In the manuscript, the authors attempt to discover a correlation of the hydraulics of the Fontan circulation with exercise performance. In doing so, they use the unique parameter, iPL, instead of the unadjusted power loss. We believe that this approach is misleading and leads to the wrong conclusion.

The term iPL was defined as:Embedded Image where PL, ρ, Q …

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  • Competing interests None.

  • Provenance and peer review Commissioned; internally peer reviewed.

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