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However, the factors influencing CRF during adolescence remain incompletely understood. The primary aim of this study was to investigate the associations between CRF and ventricular function represented by end-diastolic pressure (VEDP), the transpulmonary pressure gradient (TPG), somatic growth (height) and pulmonary diffusing capacity (DL\n                    <jats:sub>CO<\/jats:sub>\n                    \/VA). The secondary aim was to assess the prevalence of exercise oscillatory ventilation (EOV) and its physiological associations. In this national, cross-sectional study, 44 adolescents (median age 16.6 years) with Fontan circulation underwent cardiopulmonary exercise testing, heart catheterization and pulmonary function assessment. Peak oxygen uptake (V\u0307O\u2082peak) was modelled as the dependent variable in a multiple linear regression with VEDP, TPG, height, and DL\n                    <jats:sub>CO<\/jats:sub>\n                    \/VA as predictors. Logistic regression was used to identify physiological associations of EOV. The multiple regression model for absolute V\u0307O\u2082peak explained 61% of the overall variance. Lower VEDP and greater height were independently associated with higher V\u0307O\u2082peak. When V\u0307O\u2082peak was expressed relative to body mass, TPG also became associated with higher V\u0307O\u2082peak, while greater height and lower VEDP remained associated. This model explained 30% of the variance. DL\n                    <jats:sub>CO<\/jats:sub>\n                    \/VA was not independently associated with V\u0307O\u2082peak. EOV was observed in 50% of patients but showed no association with V\u0307O\u2082peak, hemodynamic, or pulmonary variables. In adolescents with Fontan circulation, lower resting VEDP and somatic growth were associated with higher CRF, reflecting more efficient hemodynamics. Pulmonary diffusing impairment and EOV were common but not significantly associated with lower CRF.\n                  <\/jats:p>","DOI":"10.1007\/s00246-026-04231-1","type":"journal-article","created":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T13:47:26Z","timestamp":1774532846000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["What Limits Cardiorespiratory Fitness in Adolescents with Fontan Circulation: An Integrated Hemodynamic and Pulmonary Perspective"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0980-0971","authenticated-orcid":false,"given":"Vibeke","family":"Klungerbo","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gaute","family":"D\u00f8hlen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Henrik","family":"Holmstr\u00f8m","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elisabeth","family":"Edvardsen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Iren Lindbak","family":"Matthews","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"M\u00f6ller","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,3,26]]},"reference":[{"key":"4231_CR1","doi-asserted-by":"publisher","unstructured":"Rychik J, Atz AM, Celermajer DS, Deal BJ, Gatzoulis MA, Gewillig MH et al (2019) Evaluation and Management of the Child and Adult With Fontan Circulation: A Scientific Statement From the American Heart Association. 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