Exercise Performance in Children and Young Adults After Complete and Incomplete Repair of Congenital Heart Disease

Abstract

Few previous studies have addressed exercise capacity in patients with corrected congenital heart disease (CHD) and significant anatomical residua. The aim of this study was to determine the aerobic fitness and peak cardiac function of patients with corrected CHD with complete or incomplete repairs, as determined by resting echocardiography. Children, adolescents and young adults (<40 years) with CHD from both sexes, who had previously undergone biventricular corrective therapeutic interventions (n = 73), and non-CHD control participants (n = 76) underwent cardiopulmonary exercise testing. The CHD group was further divided according to the absence/presence of significant anatomical residua on a resting echocardiogram ("complete"/"incomplete" repair groups). Aerobic fitness and cardiac function were compared between groups using linear regression and analysis of covariance. Peak oxygen consumption, O2 pulse and ventilatory threshold were significantly lower in CHD patients compared with controls (all p < 0.01). Compared with the complete repair group, the incomplete repair group had a significantly lower mean peak work rate, age-adjusted O2 pulse (expressed as % predicted) and a higher VE/VCO2 ratio (all p ≤ 0.05). Peak oxygen consumption was comparable between the subgroups. Patients after corrected CHD have lower peak and submaximal exercise parameters. Patients with incomplete repair of their heart defect had decreased aerobic fitness, with evidence of impaired peak cardiac function and lower pulmonary perfusion. Patients that had undergone a complete repair had decreased aerobic fitness attributed only to deconditioning. These newly identified differences explain why in previous studies, the lowest fitness was seen in patients with the most hemodynamically significant heart malformations.

“I really like playing games together”: Understanding what influences children with congenital heart disease to participate in physical activity

“…Given their recreational nature, such programmes may also be an appropriate mode of intervention for children with CHD. However, it is not known how children with more complex diagnoses of CHD (i.e., tricuspid atresia and transposition of the great arteries) will perceive their participation in these types of active settings, given they often experience motor skill delays (Marino et al, ) and decreased aerobic fitness (Rosenblum, Katz, Reuveny, Williams, & Dubnov‐Raz, ).…”

Functional Capacity in Congenital Heart Disease: A Systematic Review and Meta-Analysis

“…Patients with incomplete repair of heart defects present significant reductions in peak work rate and age-adjusted maximum ventilation as compared with their pairs who undergone complete repair. 6 Most of the published studies have a small sample size and include children, adolescents and adults, with a large range of age of subjects. 7 Thus, the present study aimed to systematically review the literature to summarize the functional capacity of children and adolescents diagnosed with CHD, through a meta-analysis of observational studies.…”

Exercise prescription improves exercise tolerance in young children with CHD: a randomised clinical trial

“…to have lower levels of aerobic fitness that can only be attributed to deconditioning, 18 and would also benefit from early identification and intervention. This study demonstrates that a structured intervention programme can significantly improve peak exercise capacity in young children with CHD.…”