Abstract
Aerobic capacity of patients with different forms of congenital heart disease was serially evaluated in 79 patients and the evolution was correlated with the lesion and the level of daily activity. The patients were divided into six groups: patients with a small ventricular septal defect (VSD) with mini shunt (n=14), mild pulmonary valve stenosis with gradient <40 mm Hg (PS) (n=12), mild to moderate aortic valve stenosis (gradient 36±17 mm Hg) (AS) (n=12), patients 4.7±2.1 years after repair of tetralogy of Fallot (PO-TF) (n=16), patients 2.2±2.9 years after closure of a high flow/high gradient VSD (PO-VSD) (n=13), and patients 2.6±1.7 years after Fontan repair (Fontan-PO) (n=12). Aerobic capacity was assessed by determination of the ventilatory anaerobic threshold (VAT). VAT reflects the highest aerobic exercise level prior to a disproportionate increase of CO2 and ventilation relative to O2 uptake; it is independent of patient motivation. Data are expressed as percentage of normal O2 uptake at VAT, determined in 234 age/gender matched controls. The habitual level of physical activity was assessed by a standardised questionnaire. Aerobic capacity in all subgroups of patients, even with very mild defects, was at or below the lower limit of normal. Children left unrestricted from physical exercise (VSD, PS, PO-VSD) had no change over the study period. However, aerobic capacity of patients with medically imposed physical restrictions (AS) and significant residual haemodynamic lesions (PO-TF, Fontan) decreased with age. In patients with AS, PO-TF and Fontan-PO the habitual level of physical activity was significantly decreased compared to controls.
Conclusion
Cardiovascular exercise performance in children with medically imposed restriction of intensive physical exercise (AS) or residual haemodynamic lesions (TF and Fontan-PO) declines progressively during medium-term follow up. In the other patient groups (VSD, PS, VSD-PO), exercise performance remains stable.
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Abbreviations
- AS :
-
aortic valve stenosis
- Fontan-PO :
-
post Fontan repair
- NYHA :
-
New York Heart Association
- PO-TF :
-
after repair for tetralogy of Fallot
- PS :
-
pulmonary valve stenosis
- VAT :
-
ventilatory anaerobic threshold
- \(\dot VE/\dot VO_2 \) :
-
ventilatory equivalent for carbon dioxide
- \(\dot VE/\dot VO_2 \) :
-
ventilatory equivalent for oxygen
- VSD :
-
ventricular septal defect
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Reybrouck, T., Rogers, R., Weymans, M. et al. Serial cardiorespiratory exercise testing in patients with congenital heart disease. Eur J Pediatr 154, 801–806 (1995). https://doi.org/10.1007/BF01959785
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DOI: https://doi.org/10.1007/BF01959785