Abnormal Postexercise Cardiovascular Recovery and Its Determinants in Patients After Right Ventricular Outflow Tract Reconstruction

Abstract

Background-Abnormal responses of heart rate (HR) and oxygen uptake (V O 2 ) during exercise characterize patients after right ventricular outflow tract reconstruction (RVOTR) for congenital heart defects. However, little is known about the postexercise dynamics. Methods and Results-We evaluated postexercise cardiovascular dynamics in 52 patients after closure of an atrioventricular septal defect (group A), 79 patients after RVOTR (group B), and 44 control subjects. HR variability, arterial baroreflex sensitivity (BRS), plasma norepinephrine, and hemodynamics were measured. Although there was no difference between group A and control subjects, declines in HR and V O 2 after light and peak exercise and in systolic blood pressure (SBP) after peak exercise were delayed in group B. Age, low-frequency component of HR variability, and plasma norepinephrine were independent determinants of early HR decline. Peak SBP and V O 2 had a great impact on the corresponding recoveries. When the peak values were excluded, body weight, BRS, and right ventricular ejection fraction were independent determinants of early SBP decline. BRS and the pulmonary artery resistance were independent determinants of V O 2 decline throughout recovery, and age and right systolic ventricular pressure also determined the early V O 2 decline. BRS and low-frequency component of HR variability were determined independently by the number of surgical procedures. Conclusions-In RVOTR patients, in addition to metabolic and autonomic maturation, surgery-related abnormal cardiac autonomic nervous activity and impaired hemodynamics have a great impact on delayed postexercise cardiovascular recovery.

Arrhythmia and reduced heart rate variability during pregnancy in women with congenital heart disease and previous reparative surgery

“…The blunted heart rate response during exercise in patients with repaired TOF is well documented [12,24]. Hemodynamic changes induced by pregnancy such as increased HR, cardiac output, volume overload and decreased systemic vascular resistance [24] were similarly observed during exercise due to oxygen demand of the body and fetus.…”

“…The blunted heart rate response during exercise in patients with repaired TOF is well documented [12,24]. Hemodynamic changes induced by pregnancy such as increased HR, cardiac output, volume overload and decreased systemic vascular resistance [24] were similarly observed during exercise due to oxygen demand of the body and fetus. Ohuchi H, et al reported [12] that parasympathetic nerve activity due to surgical damage are crucial to the HR response during exercise and are the major determinant of individual exercise capacity in patients with right ventricular outflow tract repair.…”

Post-exercise heart rate, blood pressure and oxygen uptake dynamics in pediatric patients with Fontan circulation

“…We performed cardiac catheterization with cineventriculography in 47/51 Fontan and all RVOTR patients to evaluate post-operative hemodynamics, while 25 controls underwent follow-up selective coronary angiography as described before [7][8][9][10]. We measured pressures in the cardiac chambers and great vessels.…”

“…We measured arterial baroreflex sensitivity (BRS) as an indication of cardiac vagal nervous activity using methodology reported previously [7][8][9]. The ECG, arterial blood pressure (by Finapres, Ohmeda) and respiration were recorded continuously after bolus phenylephrine administration until the blood pressure peaked.…”

“…We demonstrated that cardiovascular 0167-5273/$ -see front matter D 2005 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijcard.2004.11.008 recovery in patients after right ventricular outflow tract reconstruction (RVOTR) resembles that in both healthy individuals and adult patients with heart failure [7]. This similarity comes from the feasible stratification of biventricular CHD patients based on cardiac autonomic nervous activity (CANA) and neurohormonal factors [8].…”