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Exercise After Surgical Repair of Congenital Cardiac Lesions

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Summary

Congenital heart defects arise in approximately 1% of all live births, independent of ethnic and geographical considerations. With the development of new surgical procedures and current technologies a large number of these heart lesions can be surgically corrected in infancy. In the majority of cases patients evaluated some 10 to 20 years after surgery are asymptomatic and can lead a normal life. Despite their satisfactory clinical outcome patients may, nevertheless, show an abnormal pattern of physiological responses when submitted to dynamic exercise. This paper reviews the scientific literature concerning the exercise capabilities and the cardiorespiratory adjustments to exercise in patients surgically corrected for 4 of the most common congenital heart lesions: isolated atrial septal defect, isolated ventricular septal defects, pulmonary stenosis and tetralogy of Fallot. The maximal exercise tolerance of postoperative congenital heart defect patients may usually be related to: (a) the age of the patients at the time of surgery: (b) the severity of the lesions remaining after surgery: and (c) the age of the patients at the time of investigation. Although normal maximal exercise capabilities may be found in a good number of patients operated for either of the 4 lesions considered, this does not imply normal exercise haemodynamics. A general observation made in these 4 groups of patients is that of a subnormal exercise cardiac output which may or may not be fully compensated by an increase in peripheral oxygen extraction.

The limitation in exercising cardiac output may, in turn, be attributed to either a subnormal stroke volume or a limitation in the chronotropic response to exercise or a combination of both factors. Residual pulmonary stenosis, increased pulmonary vascular resistance, increased myocardial stiffness are all factors that may contribute to the cardiac output limitation. A thorough explanation of underlying causes for the abnormal haemodynamic response to exercise, however, still remains to be provided.

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References

  • Anderson RC, Moller JH. Ten year long follow-up of 1000 consecutive children with cardiac malformations: the University of Minnesota experience. In Engle & Perloff (Eds) Congenital heart disease after surgery: benefits, residua, sequelae, pp. 43–73, Yorke Medical Books, New York, 1983

    Google Scholar 

  • Arciniegas E. Pediatric cardiac surgery yearbook, pp. 141–153, Medical Publishers, Chicago, 1985

    Google Scholar 

  • Arciniegas E, Farooki ZQ, Hakimi M, Perry BL, Green EW. Early and late results of total correction of tetralogy of Fallot. Journal of Thoracic and Cardiovascular Surgery 80: 770–778, 1980

    PubMed  CAS  Google Scholar 

  • Behrendt DM. Atrial septal defect. In Arciniegas E (Ed.) Pediatric cardiac surgery, pp. 133–139, Year Book Medical Publishers, Chicago, 1985

    Google Scholar 

  • Bharati S, Lev M. Sequelae of atriotomy on the endocardium, conduction system and coronary arteries. In Engle & Perloff (Eds) Congenital heart disease after surgery: benefits, residua, sequelae, pp. 229–246, Yorke Medical Books, New York, 1983

    Google Scholar 

  • Bjarke B. Oxygen uptake and cardiac output during submaximal and maximal exercise in adult subjects with totally corrected tetralogy of Fallot. Acta Medica Scandinavica 197: 177–186, 1975

    Article  PubMed  CAS  Google Scholar 

  • Blake RS, Chung EE, Wesley H, Hallidie-Smith KA. Conduction defects, ventricular arrhythmias and late death after surgical closure of ventricular septal defect. British Heart Journal 47: 305–315, 1982

    Article  PubMed  CAS  Google Scholar 

  • Boccanelli AS, Wallgren CG, Zetterqvist P. Ventricular dynamics after surgical closure of ventricular septal defect. Scandinavian Journal of Thoracic and Cardiovascular Surgery 14: 153–157, 1980

    Article  PubMed  CAS  Google Scholar 

  • Bonchek L, Starr A, Sunderland CO, Menashe VD. Natural history of tetralogy of Fallot in infancy: clinical classification and therapeutic implications. Circulation 45: 392–397, 1973

    Article  Google Scholar 

  • Boucek MM, Webster HE, Orsmond GS, Ruttenberg HD. Balloon pulmonary valvotomy: palliation for cyanotic heart disease. American Heart Journal 115(2): 318–322, 1988

    Article  PubMed  CAS  Google Scholar 

  • Cumming GR. Maximal exercise capacity of children with heart defects. American Journal of Cardiology 42: 613–619, 1978

    Article  PubMed  CAS  Google Scholar 

  • Cumming GR. Maximal supine exercise hemodynamics after open heart surgery for Fallot’s tetralogy. British Heart Journal 41: 683–691, 1979

    Article  PubMed  CAS  Google Scholar 

  • Cumming GR. Children with heart disease. In Skinner (Ed.) Exercise testing and exercise prescription for special cases: theoretical basis and clinical application, pp. 241–260, Lea & Febiger, Philadelphia, 1987

    Google Scholar 

  • Dave KS, Pakraski BC, Wooler GH, Ionescu MI. Atrial septal defects in adults: clinical and hemodynamic results of surgery. American Journal of Cardiology 31: 7–13, 1973

    Article  PubMed  CAS  Google Scholar 

  • Drblik SP. Cardiorespiratory response to upright exercise in tetralogy of Fallot adolescents after surgical correction, Master’s Thesis, McGill University, Montreal, Quebec, 1988

    Google Scholar 

  • Emmanouilides GC, Baylen BG. Pulmonary stenosis. In Moss & Adams (Eds) Heart disease in infants, children and adolescents, pp. 234–261, Williams & Wilkins Co., Baltimore, 1983

    Google Scholar 

  • Epstein SE, Beiser GD, Goldstein RE, Rosing DR, Redwood DR, et al. Hemodynamic abnormalities in response to mild and intense upright exercise following operative correction of an atrial septal defect or tetralogy of Fallot. Circulation 47: 1065–1075, 1973

    Article  PubMed  CAS  Google Scholar 

  • Fallot EAL. Contribution à l’anatomie pathologique de la maladie bleue (cyanose cardiaque). Marseille Medicale 25: 77–93, 207–223, 270–286, 341–354, 403–420, 1888

    Google Scholar 

  • Feldt RH, Edwards WD, Puga FJ, Seward JB, Weidman WH. Atrial septal defects and atrioventricular canal. In Moss & Adams (Eds) Heart disease in infants, children and adolescents, pp. 118–134, Williams & Wilkins Co., Baltimore, 1983

    Google Scholar 

  • Finnegan P, Haider R, Patel RG, Abrams LD, Singh SP. Results of total correction of the tetralogy of Fallot: long term haemodynamic evaluation at rest and during exercise. British Heart Journal 38: 934–942, 1976

    Article  PubMed  CAS  Google Scholar 

  • Finnegan P, Ihenacho HNC, Singh SP, Abrams LD. Haemodynamic studies at rest and during exercise in pulmonary stenosis after surgery. British Heart Journal 36: 913–918, 1974

    Article  PubMed  CAS  Google Scholar 

  • Forfang K, et al. Haemodynamic findings before and after surgery for atrial septal defect of the secundum type in middle-aged patients. Cardiology 63: 14–32, 1978

    Article  PubMed  CAS  Google Scholar 

  • Freed MD. Recreational and sports recommendations for the child with heart disease. Pediatric Clinics of North America 31: 1307–1320, 1984

    PubMed  CAS  Google Scholar 

  • Friedli B, Kidd BSL, Mustard WT, Keith JD. Ventricular septal defect with increased pulmonary vascular resistance. American Journal of Cardiology 33: 403–409, 1974

    Article  PubMed  CAS  Google Scholar 

  • Furuse A, Wake K, Kotsuka Y, Asano K. Conduction disturbance and tachyarrhythmia in postoperative ventricular septal defect and tetralogy of Fallot. Japanese Circulation Journal 50: 850–854, 1986

    Article  PubMed  CAS  Google Scholar 

  • Fuster V, McGoon DC, Kennedy MA, Ritter DG, Kirklin JW. Long-term evaluation (12–22 years) of open heart surgery for tetralogy of Fallot. American Journal of Cardiology 46: 635–642, 1980

    Article  PubMed  CAS  Google Scholar 

  • Gillette PC, Yeoman MA, Mullins CE, McNamara DG. Sudden death after repair of tetralogy of Fallot. Circulation 56: 566–571, 1977

    Article  PubMed  CAS  Google Scholar 

  • Goldberg B, Fripp RR, Lister G, Loke J, Nicholas JA, et al. Effect of physical training on exercise performance of children following surgical repair of congenital heart disease. Pediatrics 68(5): 691–699, 1981

    PubMed  CAS  Google Scholar 

  • Gotsman MS. Increasing obstruction to the outflow tract in Fallot’s tetralogy. British Heart Journal 28: 615–621, 1966

    Article  PubMed  CAS  Google Scholar 

  • Graham TP. Ventricular performance in adults after operation for congenital heart disease. American Journal of Cardiology 50: 612–620, 1982

    Article  PubMed  Google Scholar 

  • Graham TP, Bender HW, Spach MS. Ventricular septal defect. In Moss & Adams (Eds) Heart disease in infants, children, and adolescents, pp. 134–154, Williams & Wilkins Co., Baltimore, 1983

    Google Scholar 

  • Hairston P, Parker EF, Arrants JE, Bradham RR, Lee Jr W. The adult atrial septal defect: results of surgical repair. Annals of Surgery 179: 799–804, 1974

    Article  PubMed  CAS  Google Scholar 

  • Hallide-Smith KA, Wilson RSE, Hart A, Zeidifard E. Functional status of patients with large ventricular septal defect and pulmonary vascular disease 6 to 16 years after surgical closure of their defect in childhood. British Heart Journal 39: 1093–1101, 1977

    Article  Google Scholar 

  • Hannon JD, Danielson GK, Puga FJ, Heise CT, Driscoll DJ. Cardiorespiratory response to exercise after repair of tetralogy of Fallot. Texas Heart Institute Journal 12(4): 393–400, 1985

    PubMed  CAS  Google Scholar 

  • Hirschfeld S, Tuboku-Metzger AJ, Borkat G, Ankeney J, Clayman J, et al. Comparison of exercise and catheterization results following total surgical correction of tetralogy of Fallot. Journal of Thoracic and Cardiovascular Surgery 75(3): 446–451, 1978

    PubMed  CAS  Google Scholar 

  • Hoffman JIE. The natural history of congenital isolated pulmonic and aortic stenosis. Annual Review of Medicine 20: 15–28, 1969

    Article  PubMed  CAS  Google Scholar 

  • Hoffman JIE, Rudolph AM. The natural history of ventricular septal defects in infancy. American Journal of Cardiology 62: 634–653, 1965

    Article  Google Scholar 

  • Ikkos D, Jonsson B, Linderholm H. Effect of exercise in pulmonary stenosis with intact ventricular septum. British Heart Journal 28: 316–330, 1966

    Article  PubMed  CAS  Google Scholar 

  • Jaimahani J, Graham T, Canent R, Jewett PL. Left heart function in children with tetralogy of Fallot before and after palliative or corrective surgery. Circulation 46: 478–490, 1972

    Article  Google Scholar 

  • James FW, Blomqvist CG, Freed MD, Miller WW, Moller JH, et al. Standards for exercise testing in the pediatric age group. American Heart Association Council on Cardiovascular Disease of the Young. Ad hoc committee on exercise testing. Circulation 66: 1377A–1397A, 1982

    PubMed  CAS  Google Scholar 

  • James FW, Kaplan S, Schwartz DC, Chou T, Sandker M, et al. Response to exercise in patients after surgical correction of tetralogy of Fallot. Circulation 54(4): 671–677, 1976

    Article  PubMed  CAS  Google Scholar 

  • Johnson AM. Impaired exercise response and other residua of pulmonary stenosis after valvotomy. British Heart Journal 24: 375–388, 1968

    Article  Google Scholar 

  • Jonsson B, Lee SJK. Haemodynamic effects of exercise in isolated pulmonary stenosis before and after surgery. British Heart Journal 30: 60–66, 1968

    Article  PubMed  CAS  Google Scholar 

  • Kan JS, White Jr RI, Mitchell SE, Gardner TJ. Percutaneous balloon valvuloplasty: a new method for treating congenital pulmonary-valve stenosis. New England Journal of Medicine 307: 540–542, 1982

    Article  PubMed  CAS  Google Scholar 

  • Keith JD. Prevalence, incidence and epidemiology. In Keith JD, et al. (Eds) Heart disease in infancy and childhood, pp. 3–13, Macmillan Publishing Co., New York, 1978

    Google Scholar 

  • Kirklin JW, Barratt-Boyes BG. Cardiac surgery: morphology, diagnostic criteria, natural history, techniques, results and indications, pp. 699–819, John Wiley & Sons, New York, 1986

    Google Scholar 

  • Kirklin JW, Karp RB. The tetralogy of Fallot from a surgical point of view, WB Saunders Company, Philadelphia, 1970

    Google Scholar 

  • Kulbertus HE, Coyne JJ, Hallide-Smith KA. Conduction disturbances before and after surgical closure of ventricular septal defect. American Heart Journal 77: 123–130, 1969

    Article  PubMed  CAS  Google Scholar 

  • Kulik TJ, Bass JL, Fuhrman BP, Moller JH, Lock JE. Exercise induced pulmonary vasoconstriction. British Heart Journal 50: 59–64, 1983

    Article  PubMed  CAS  Google Scholar 

  • Lambert J, Ferguson RJ, Gervais A, Gilbert G. Exercise capacity, residual abnormalities and activity habits following total correction for tetralogy of Fallot. Cardiology 66: 120–131, 1980

    Article  PubMed  CAS  Google Scholar 

  • Liberthson RR, Boucher CA, Strauss HW, Dinsmore RE, McKusick KA, et al. Right ventricular function in adult atrial septal defect: preoperative and postoperative assessment and clinical implications. American Journal of Cardiology 47: 56–60, 1981

    Article  PubMed  CAS  Google Scholar 

  • Lillehei CW, Varco RL, Cohen M, Warden HE, Gott VL, et al. The first open heart corrections for tetralogy of Fallot: a 26–31 year follow-up of 106 patients. Annals of Surgery 204(4): 490–501, 1986

    Article  PubMed  CAS  Google Scholar 

  • Maron BJ, Redwood DR, Hirshfeld Jr JW, Goldstein RE, Morrow AG, et al. Postoperative assessment of patients with ventricular septal defect and pulmonary hypertension: response to intense upright exercise. Circulation 48: 864–874, 1973

    Article  PubMed  CAS  Google Scholar 

  • McNamara DG, Latson LA. Long term follow-up of patients with malformations for which definitive surgical repair has been available for 25 years or more. American Journal of Cardiology 50: 560–567, 1982

    Article  PubMed  CAS  Google Scholar 

  • McNamara DG, Latson LA. Long-term follow-up of patients with malformations for which definitive surgical repair has been available for 25 years or more. In Engle MA & Perloff JK (Eds) Congenital heart disease after surgery: benefits, residua, sequelae, pp. 77–99, Yorke Medical Books, New York, 1983

    Google Scholar 

  • Mitchell SC, Korones SB, Berendes HW. Congenital heart disease in 56,109 births: incidence and natural history. Circulation 43: 323–331, 1971

    Article  PubMed  CAS  Google Scholar 

  • Miyamura H, Kanazawa H, Fukuda J, Eguchi S, Morikawa M, et al. Long-term postoperative status of tetralogy of Fallot. Japanese Circulation Journal 50: 855–858, 1986

    Article  PubMed  CAS  Google Scholar 

  • Mocellin R, Bastanier C, Hofacker W, Buhlmeyer K. Exercise performance in children and adolescents after surgical repair of tetralogy of Fallot. European Journal of Cardiology 413: 367–374, 1976

    Google Scholar 

  • Moller JH, Neal WA. Heart disease in infancy, pp. 1–15, 172–181, 236–243, Appleton-Century-Crofts, New York, 1981

    Google Scholar 

  • Moller JH, Satyanarayana R, Lucas Jr RV. Exercise hemodynamics of pulmonary valvular stenosis. Circulation 46: 1018–1026, 1972

    Article  PubMed  CAS  Google Scholar 

  • Niederhauser H, Simonin P, Friedli B. Sinus node function and conduction system after complete repair of tetralogy of Fallot. Circulation 52: 214–220, 1975

    Article  PubMed  CAS  Google Scholar 

  • Ning S, Haydarally F, Cook D, Wood MM, Duncan WJ, et al. Right ventricular size and ventricular septal motion after repair of atrial septal defect in children. Canadian Journal of Surgery 27(4): 395–398, 1984

    CAS  Google Scholar 

  • Nugent WE, Freedom RM, Nora JJ, Ellison RC, Rowe RD, et al. Clinical course in pulmonary stenosis. Circulation 56 (Suppl. 2): 38–42, 1977

    Google Scholar 

  • Okoroma EO, Guller B, Maloney JD, Weidman WH. Etiology of right bundle branch block pattern after surgical closure of ventricular septal defects. American Heart Journal 90: 14–18, 1975

    Article  PubMed  CAS  Google Scholar 

  • Otterstad JE, Simonsen S, Erikssen J. Hemodynamic findings at rest and during mild supine exercise in adults with isolated, uncomplicated ventricular septal defects. Circulation 71(4): 650–662, 1985

    Article  PubMed  CAS  Google Scholar 

  • Pacifico AD, Sand ME. Advances in the surgical management of congenital heart disease in infants and children. In McGoon (Ed.) Cardiac surgery, Vol. 17, Cardiovascular clinics, pp. 414–431, FA Davis Company, Philadelphia, 1987

    Google Scholar 

  • Pearlman AS, Borer JS, Clark CE, Henre WL, Redwood DR, et al. Abnormal right ventricular size and ventricular septal motion after atrial septal defect closure. American Journal of Cardiology 41: 295–301, 1978

    Article  PubMed  CAS  Google Scholar 

  • Perrault H, Drblik S, Montigny M, Davignon A, Lamarre A. Comparative response to exercise in surgically corrected heart defects. Abstract. Canadian Journal of Sport Sciences 12(3): 18P, 1987

    Google Scholar 

  • Petersson PO. Atrial septal defect of secundum type: a clinical study before and after operation with special reference to haemodynamic function. Acta Paediatrica Scandinavica (Suppl. 174): 5, 1967

    Google Scholar 

  • Puviani G, Della Casa L, Venezia L. Systolic time intervals in isolated septal defects before and after corrective surgery. Cardiology 71: 177–183, 1984

    Article  PubMed  CAS  Google Scholar 

  • Quattlebaum TG, Vanghese PJ, Neill CA, Sonahoo JS. Sudden death among postoperative patients with tetralogy of Fallot. Circulation 54: 289–293, 1976

    Article  PubMed  CAS  Google Scholar 

  • Reduto LA, Berger HJ, Johnstone DE, Hellenbrand W, Wackers FJ, et al. Radionuclide assessment of right and left ventricular exercise reserve after total correction of tetralogy of Fallot. American Journal of Cardiology 45: 1013–1018, 1980

    Article  PubMed  CAS  Google Scholar 

  • Reybrouck T, Weymans M, Stijns H, Van der Hauwaert LG. Exercise testing after correction of tetrology of Fallot: the fallacy of a reduced heart rate response. American Heart Journal 112: 998–1003, 1986

    Article  PubMed  CAS  Google Scholar 

  • Rocchini AP. Hemodynamic abnormalities in response to supine exercise in patients after operative correction of tetrad of Fallot after early childhood. American Journal of Cardiology 48: 325–330, 1981

    Article  PubMed  CAS  Google Scholar 

  • Rosenthal A. Care of the postoperative child and adolescent with congenital heart disease. Advances in Pediatrics 30: 131–167, 1983

    PubMed  CAS  Google Scholar 

  • Rosing D, Borer J, Kent KM, Maron BJ, Seides SF, et al. Long-term hemodynamic and electrocardiographic assessment following operative repair of tetralogy of Fallot. Circulation 58 (Suppl. 1): 209–217, 1978

    Google Scholar 

  • Rowe RD, Vlad P, Keith JD. Experiences with 180 cases of tetralogy of Fallot in infants and children. Canadian Medical Association Journal 73: 23–30, 1955

    PubMed  CAS  Google Scholar 

  • Rudolph AM. Congenital diseases of the heart: clinical-physiologic considerations in diagnosis and management, Year Book Medical Publishers, Chicago, 1974

    Google Scholar 

  • Sondheimer HM, Izukawa T, Olley PM, Trusler GA, Mustard WT. Conduction disturbances after total correction of tetralogy of Fallot. American Heart Journal 92: 278–288, 1976

    Article  PubMed  CAS  Google Scholar 

  • Stone FM, Bessinger FB, Lucas RV, Moller JH. Pre- and postoperative rest and exercise hemodynamics in children with pulmonary stenosis. Circulation 49: 1102–1106, 1974

    Article  PubMed  CAS  Google Scholar 

  • Subramanian S. Right ventricular outflow tract obstruction. In Arciniegas (Ed.) Pediatric cardiac surgery, pp. 185–191, Year Book Medical Publishers, Chicago, 1985

    Google Scholar 

  • Takahashi O, Futaki S, Kamiya T. Exercise capacity of patients with post-operative tetralogy of Fallot. Japanese Circulation Journal 50: 863–864, 1986

    Article  PubMed  CAS  Google Scholar 

  • Tamer D, Wolff GS, Ferrer P, Pickoff AS, Casta A, et al. Hemodynamics and intracardiac conduction after operative repair of tetralogy of Fallot. American Journal of Cardiology 51: 552–556, 1983

    Article  PubMed  CAS  Google Scholar 

  • Taussig HB. World survey of the common cardiac malformations: developmental error or genetic variant? In Engle & Perloff (Eds) Congenital heart disease after surgery: benefits, residua, sequelae, pp. 1–42, Yorke Medical Books, New York, 1983

    Google Scholar 

  • Vetter VL, Horowitz LN. Electrophysiologic residua and sequelae of surgery for congenital heart defects. In Engle & Perloff (Eds) Congenital heart disease after surgery: benefits, residua, sequelae, pp. 261–305, Yorke Medical Books, New York, 1983

    Google Scholar 

  • Wallgren CG, Boccanelli A, Zetterqvist P, Bjork VO. Late results after surgical closure of ventricular septal defect in children. Scandinavian Journal of Thoracic and Cardiovascular Surgery 14: 145–151, 1980

    Article  PubMed  CAS  Google Scholar 

  • Wells WJ, Lindesmith GG. Ventricular septal defect. In Arciniegas E (Ed.) Pediatric cardiac surgery, pp. 141–153, Year Book Medical Publishers, 1985

    Google Scholar 

  • Wessel HU, Cunningham WJ, Paul MH, Bastanier CK, Muster AJ, et al. Exercise performance in tetralogy of Fallot after intracardiac repair. Journal of Thoracic and Cardiovascular Surgery 80(4): 582–593, 1980

    PubMed  CAS  Google Scholar 

  • Wolff GS, Rowland TW, Ellison RC. Surgically induced right bundle branch block with left anterior hemiblock. Circulation 46: 587–594, 1972

    Article  PubMed  CAS  Google Scholar 

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  1. Department of Physical Education, McGill University, 475 Pine Ave West, Montreal, Quebec, H2W 154, Canada

    Hélène Perrault & Susan P. Drblik

  2. Cardiopulmonary Unit, St Justine’s Hospital for Children, Montreal, Quebec, Canada

    Hélène Perrault & Susan P. Drblik

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  1. Hélène Perrault
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  2. Susan P. Drblik
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Perrault, H., Drblik, S.P. Exercise After Surgical Repair of Congenital Cardiac Lesions. Sports Med 7, 18–31 (1989). https://doi.org/10.2165/00007256-198907010-00002

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