Cardiopulmonary Exercise Testing in Children Following Surgery for Tetralogy of Fallot

Tomassoni, Teresa L.; Galioto, Frank M.; Vaccaro, Paul

doi:10.1001/archpedi.1991.02160110082025

Cited by 10 publications

(7 citation statements)

References 25 publications

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“…Non‐invasive methods have been developed to estimate cardiac output, using exchange techniques. Our indirect Fick re‐breathing (acetylene‐helium) was validated in similar studies of healthy children or young patients with congenital heart diseases (11–22).…”

Section: Discussionmentioning

confidence: 97%

Cardiorespiratory functional assessment after pediatric heart transplantation

Pastore¹,

Turchetta²,

Attias³

et al. 2001

Pediatric Transplantation

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Limited data are available on the exercise capacity of young heart transplant recipients. The aim of this study was therefore to assess cardiorespiratory responses to exercise in this group of patients. Fourteen consecutive heart transplant recipients (six girls and eight boys, age-range 5-15 yr) and 14 healthy matched controls underwent a Bruce treadmill test to determine: duration of test; resting and maximum heart rates; maximum systolic blood pressure; peak oxygen consumption (VO2 peak); and cardiac output. Duration of test and heart rate increase were then compared with: time since transplantation, rejections per year, and immunosuppressive drugs received. The recipients also underwent the following lung function tests: forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1). When compared with healthy controls, transplant recipients had tachycardia at rest (126 +/- 3.7 beats/min; p < 0.001); significantly reduced tolerance (9.3 +/- 0.4 min; p < 0.001), a maximum heart rate of 169 +/- 5.4 beats/min (p < 0.05); a cardiac output of 5.65 +/- 0.6 L/min (p < 0.05); and a lower heart-rate increase from rest to peak exercise (p < 0.001) but a similar VO2 peak. The heart-rate increase correlated significantly with time post-transplant (r = 0.55; p < 0.05), number of rejection episodes per year (r = - 0.63; p < 0.05), and number of immunosuppressive drugs (r = - 0.60; p < 0.05). The recipients had normal FVC and FEV1 values. After surgery, few heart transplant recipients undertake physical activity, possibly owing to over-protective parents and teachers and to a lack of suitable supervised facilities. The authors stress the importance of a cardiorespiratory functional evaluation for assessment of health status and to encourage recipients, if possible, to undertake regular physical activity.

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Section: Discussionmentioning

confidence: 97%

Cardiorespiratory functional assessment after pediatric heart transplantation

Pastore¹,

Turchetta²,

Attias³

et al. 2001

Pediatric Transplantation

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“…1,6,23 In these patients, long-term pulmonary arterial stenosis may lead to differential lung growth, reduced cardiac performance 17 and decreased exercise capacity. 28,39 The model of the tetralogy of Fallot patient's circulation illustrates the importance of simulation in the presence of residual stenosis, suggesting that surgical repair of the apparent stenosis may do little to benefit this particular patient. A plausible explanation for this result is that the reduced growth of the left lung, likely due to the stenosis in question, has given its arterial tree a total resistance much larger than that of the stenosis itself.…”

Section: Discussionmentioning

confidence: 99%

Morphometry-Based Impedance Boundary Conditions for Patient-Specific Modeling of Blood Flow in Pulmonary Arteries

et al. 2007

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Patient-specific computational models could aid in planning interventions to relieve pulmonary arterial stenoses common in many forms of congenital heart disease. We describe a new approach to simulate blood flow in subject-specific models of the pulmonary arteries that consists of a numerical model of the proximal pulmonary arteries created from three-dimensional medical imaging data with terminal impedance boundary conditions derived from linear wave propagation theory applied to morphometric models of distal vessels. A tuning method, employing numerical solution methods for nonlinear systems of equations, was developed to modify the distal vasculature to match measured pressure and flow distribution data. One-dimensional blood flow equations were solved with a finite element method in image-based pulmonary arterial models using prescribed inlet flow and morphometry-based impedance at the outlets. Application of these methods in a pilot study of the effect of removal of unilateral pulmonary arterial stenosis induced in a pig showed good agreement with experimental measurements for flow redistribution and main pulmonary arterial pressure. Next, these methods were applied to a patient with repaired tetralogy of Fallot and predicted insignificant hemodynamic improvement with relief of the stenosis. This method of coupling image-based and morphometry-based models could enable increased fidelity in pulmonary hemodynamic simulation.

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“…Fifteen studies were conducted in Europe ( 18 – 32 ), three in the United States ( 33 – 35 ), one in Brazil ( 36 ), one in Japan ( 37 ), and one was conducted in Egypt ( 38 ). Regarding the design, 20 were cross-sectional ( 18 – 23 , 25 – 38 ), and only one was an RCT ( 24 ).…”

Section: Resultsmentioning

confidence: 99%

Exercise Capacity in Children and Adolescents With Congenital Heart Disease: A Systematic Review and Meta-Analysis

Villaseca-Rojas

Varela-Melo

Torres‐Castro

et al. 2022

Front. Cardiovasc. Med.

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BackgroundCongenital heart disease (CHD) entails structural defects in the morphogenesis of the heart or its main vessels. Analyzing exercise capacity of children and adolescents with CHD is important to improve their functional condition and quality of life, since it can allow timely intervention on poor prognostic factors associated with higher risk of morbidity and mortality.ObjectiveTo describe exercise capacity in children and adolescents with CHD compared with healthy controls.MethodsA systematic review was carried out. Randomized clinical trials and observational studies were included assessing exercise capacity through direct and indirect methods in children and adolescents between 5 and 17 years-old. A sensitive analysis was performed including studies with CHD repaired participants. Additionally, it was sub-analyzed by age range (< and ≥ 12 years old). Two independent reviewers analyzed the studies, extracted the data, and assessed the quality of the evidence.Results5619 articles were found and 21 were considered for the review. Eighteen articles used the direct exercise capacity measurement method by cardiopulmonary exercise test (CPET). The CHD group showed significant differences in peak oxygen consumption (VO2peak) with a value of −7.9 ml/Kg/min (95% CI: −9.9, −5.9, p = 0.00001), maximum workload (Wmax) −41.5 (95% CI: −57.9, −25.1 watts, p = 0.00001), ventilatory equivalent (VE/VCO2) slope 2.6 (95% CI: 0.3, 4.8), oxygen pulse (O2 pulse)−2.4 ml/beat (95% CI: −3.7, −1.1, p = 0.0003), and maximum heart rate (HRmax) −15 bpm (95% CI: −18, −12 bpm, p = 0.00001), compared with healthy controls. Adolescents (≥ 12 yrs) with CHD had a greater reduction in VO2peak (−10.0 ml/Kg/min (95% CI: −12.0, −5.3), p < 0.00001), Wmax (−45.5 watts (95% CI: −54.4, −36.7), p < 0.00001) and HRmax (−21 bpm (95% CI: −28, −14), p<0.00001).ConclusionSuffering CHD in childhood and adolescence is associated with lower exercise capacity as shown by worse VO2peak, Wmax, VE/VCO2 slope, O2 pulse, and HRmax compared with matched healthy controls. The reduction in exercise capacity was greater in adolescents.Systematic Review Registrationwww.crd.york.ac.uk/prospero/display_record.php?RecordID=208963, identifier: CRD42020208963.

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Cardiopulmonary Exercise Testing in Children Following Surgery for Tetralogy of Fallot

Cited by 10 publications

References 25 publications

Cardiorespiratory functional assessment after pediatric heart transplantation

Cardiorespiratory functional assessment after pediatric heart transplantation

Morphometry-Based Impedance Boundary Conditions for Patient-Specific Modeling of Blood Flow in Pulmonary Arteries

Exercise Capacity in Children and Adolescents With Congenital Heart Disease: A Systematic Review and Meta-Analysis

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