Comparison of the Degree of Exercise Tolerance in Children After Surgical Treatment of Complex Cardiac Defects, Assessed Using Ergospirometry and the Level of Brain Natriuretic Peptide

Abstract

Children who underwent surgery for complex congenital heart defects present worse exercise capacity than their healthy peers. In adults and adolescents, heart failure is assessed on the basis of clinical symptoms using the New York Heart Association (NYHA) score, while in an infant Ross scale; heart failure can also be evaluated by other parameters. The purpose of this study was to compare the degree of exercise tolerance in children after surgery for complex heart defects, assessed by the ratio of maximum oxygen uptake (VO2max) and the brain natriuretic peptide (N-terminal fragment of the prohormone brain-type natriuretic peptide [NT-proBNP]) concentration.The study group consisted of 42 children, ages 9 to 17 years (mean 14.00 ± 2.72). Among them there were 22 children with tetralogy of Fallot (ToF) after total correction, 18 children with transposition of the great arteries (d-TGA) after the arterial switch operation, and 2 children with single ventricle (SV) after the Fontan operation. All but 1 child were in NYHA class I. The control group consisted of 20 healthy children. Outcomes of interest were the ratio of VO2max, determined during ergospirometry, and the level of NT-proBNP. The statistical analysis was performed and the groups were considered significantly different for P < 0.05.There was no statistically significant correlation between NT-proBNP and maximum oxygen uptake (VO2) kg−1 min−1 in the study group compared with the control group.The VO2max in the test group had a mean value less (34.6 ± 8.0) than controls (38.4 ± 7.7), and the differences were statistically significant (P = 0.041). In contrast, the average concentration of NT-proBNP in the study group was higher than controls (117.9 ± 74.3 vs 18.0 ± 24.5), and these differences were statistically significant (P < 0.001).After operations for complex heart defects (ToF, TGA, and SV), children have worse heart function parameters and exercise capacity than the healthy population. To control this, we recommend postoperative ergospirometry and determination of NT-proBNP concentrations.

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

“…Among the studies, the CHD sample size ranged from 12 ( 30 ) to 496 ( 21 ). Age varied from 7.7 ± 1.7 ( 28 ) to 14 ± 2.72 ( 20 ). The majority of the studies included only complex CHD ( 18 – 20 , 22 , 25 , 27 , 31 , 33 – 36 , 38 ), and nine studies included both simple and complex CHD ( 21 – 24 , 26 , 28 – 30 , 32 , 37 ).…”

“…Age varied from 7.7 ± 1.7 ( 28 ) to 14 ± 2.72 ( 20 ). The majority of the studies included only complex CHD ( 18 – 20 , 22 , 25 , 27 , 31 , 33 – 36 , 38 ), and nine studies included both simple and complex CHD ( 21 – 24 , 26 , 28 – 30 , 32 , 37 ). Sixteen studies included only repaired CHD ( 18 – 20 , 22 , 24 – 27 , 30 , 31 , 33 – 38 ); however, only ten studies reported the age of surgery, which was before 3 years old in the majority of the cases ( 19 , 22 , 26 – 28 , 30 , 33 ).…”

“…To assess exercise capacity, 18 studies used the direct CPET method: seven of them performed the CPET on a treadmill ( 18 – 20 , 27 , 36 – 38 ) and 13 in a cycle ergometer ( 21 – 26 , 29 – 35 ). One study used the 6MWT ( 24 ).…”

“…Those who performed CPET on a treadmill had on average −9.6 ml/Kg/min (95% CI: −14.0, −5.2) of VO 2 peak compared with the control group ( p < 0.0001) and those who performed test on cycle ergometer had an average of −7.1 ml/Kg/min (95% CI: −9.3, −5.0) of VO 2 peak as compared with the control group (p<0.00001). If we analyze only studies with patients surgically repaired ( 19 , 20 , 22 , 24 – 27 , 30 , 31 , 33 – 37 ), the participants with CHD averaged −8.7 ml/Kg/min (95% CI: −12.0, −5.4) of VO 2 peak compared with controls ( p < 0.00001, I 2 = 92%) ( Supplementary File 2 , Figure 1 ). In addition, we sub-analyzed by age range and observed that the VO 2 peak of the group under 12 years old had a decrease of −7.1 ml/Kg/min (95% CI: −11.7, −2.4) compared with the control group ( p < 0.00001, I 2 = 89%), and the group ≥ 12 years old had a reduction of −10.0 ml/Kg/min (95% CI: −12.0, −5.3) compared with the control group ( p < 0.00001, I 2 = 82%) ( Figure 3 ).…”

Going home after a child’s cardiac surgery: education for safe care

“…After performing a cardiac defect correction procedure, it is important to provide information on hygiene, food (8)(9) , physical activities (10)(11) and others, which may still raise doubts for children's caregivers. To enhance positive responses in child care, educational practices are suggested, with the insertion of concepts of health promotion and empowerment of families of children with heart disease (6)(7)(12)(13) .…”