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

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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.

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Acknowledgments

This study was performed in partial fulfillment of the requirements for an MD degree by Dr. Omer Rosenblum at the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

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    Authors and Affiliations

    1. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

      Omer Rosenblum, Uriel Katz & Gal Dubnov-Raz

    2. Edmond J. Safra International Congenital Heart Center, The Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel Hashomer, Israel

      Uriel Katz & Ronen Reuveny

    3. Children’s Health and Exercise Research Center, Sport and Health Sciences, University of Exeter, Exeter, UK

      Craig A. Williams

    4. Exercise, Nutrition and Lifestyle Clinic, The Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel Hashomer, Israel

      Gal Dubnov-Raz

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    1. Omer Rosenblum
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    Correspondence to Gal Dubnov-Raz.

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    Omer Rosenblum and Uriel Katz have contributed equally to this paper.

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    Rosenblum, O., Katz, U., Reuveny, R. et al. Exercise Performance in Children and Young Adults After Complete and Incomplete Repair of Congenital Heart Disease. Pediatr Cardiol 36, 1573–1581 (2015). https://doi.org/10.1007/s00246-015-1198-1

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    • DOI: https://doi.org/10.1007/s00246-015-1198-1

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