Background: Patients with Senning repair for complete transposition of the great arteries (d-TGA) show an impaired exercise tolerance. Our aim was to investigate changes in exercise capacity in children, adolescents and adults with Senning operation. Methods: Peak oxygen uptake (peak VO2), oxygen pulse and heart rate were assessed by cardiopulmonary exercise tests (CPET) and compared to normal values. Rates of change were calculated by linear regression analysis. Right ventricular (RV) function was assessed by echocardiography. Results: Thirty-four patients (22 male) performed 3.5 (range 3–6) CPET with an interval of ≥ 6 months. Mean age at first assessment was 16.4 ± 4.27 years. Follow-up period averaged 6.8 ± 2 years. Exercise capacity was reduced (p<0.0005) and the decline of peak VO2 (−1.3 ± 3.7 %/year; p=0.015) and peak oxygen pulse (−1.4 ± 3.0 %/year; p=0.011) was larger than normal, especially before adulthood and in female patients (p<0.01). During adulthood, RV contractility changes were significantly correlated with the decline of peak oxygen pulse (r= −0.504; p=0.047). Conclusions: In patients with Senning operation for d-TGA, peak VO2 and peak oxygen pulse decrease faster with age compared to healthy controls. This decline is most obvious during childhood and adolescence, and suggests the inability to increase stroke volume to the same extent as healthy peers during growth. Peak VO2 and peak oxygen pulse remain relatively stable during early adulthood. However, when RV contractility decreases, a faster decline in peak oxygen pulse is observed
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Objectives Patients who underwent corrective surgery for tetralogy of Fallot (TOF) have increased long-term risk of cardiovascular morbidity and mortality. Yet, limited information is available on how to evaluate the risk in this population. Therefore, the aim of this study was to investigate the prognostic value of aerobic exercise capacity, along with other related parameters, at medium-term follow-up in adult patients with tetralogy of Fallot. Methods and results Between 2000 and 2003, 92 adults (age 26.2 ± 7.8 years; 63 male) with corrected TOF or TOF-type morphology underwent a cardiopulmonary exercise test (CPET) until exhaustion and echocardiography. During a mean follow-up of 7.3 ± 1.2 years (range 0.9 to 9.3 years), 2 patients died and 26 patients required at least 1 cardiac-related intervention at a mean age of 28.9 ± 7.9 years. Event-free survival tended to be higher in patients with the classical type of TOF (P = 0.061). At multivariate Cox analysis, age at CPET [hazard ratio (HR): 1.13, P = 0.006], age at correction (HR: 0.82, P = 0.037), right ventricular (RV) function (HR: 4.94, P = 0.001), QRS duration (HR: 1.02, P = 0.007), percentage of predicted peak oxygen uptake (peak VO2%) (HR: 0.96, P = 0.029) and ventilatory effi ciency slope (VE/VCO2 slope) (HR: 1.13, P = 0.021) were signifi cantly related to the incidence of death/cardiac-related intervention during medium follow-up. Conclusions Early corrective surgery and a well-preserved RV are associated with a better outcome in adults with corrected TOF. Furthermore, CPET provides important prognostic information; peak VO2% and VE/VCO2 slope are independent predictors for event-free survival in patients with corrected TOF.
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Abstract Purpose: This study aimed at evaluating (1) right ventricular (RV) mean power during exercise, (2) the contribution of flow and pressure to RV mean power, and (3) the impact of pulmonary artery pressure on RV function during exercise. Methods: Fifty patients with atrial septal defect (ASD) type secundum (20 open, 30 closed) were enrolled. All underwent standard echocardiography, a bicycle stress echocardiography, and symptom-limited cardiopulmonary exercise testing. RV mean power was calculated as the product of RV cardiac output and mean pulmonary artery pressure (mPAP). RV function was assessed using RV fractional area change (FAC) at rest and at peak exercise. Results: RV mean power was linearly related with oxygen uptake (VO2) in patients with open (R2¼0.88; p<0.0001) and closed ASD (R2¼0.90; p<0.0001). The increase in RV mean power was steeper in open than in closed ASD patients (p<0.0001). The change in RV cardiac output (7.13.4 vs. 5.72.4 l/min; p¼0.132) was not statistically different, but the change in mPAP (21.79.6 vs. 12.84.6 mmHg; p<0.0001) and RV mean power (0.970.56 vs. 0.530.22 W; p¼0.009) were higher in patients with an open ASD. The change in RV FAC from rest to peak exercise was related to peak mPAP in open (R¼0.589; p¼0.010) and closed (R¼0.450; p¼0.021) ASD patients. Conclusion: RV mean power during exercise is higher in patients with an open than in patients with a closed ASD. The workload of the RV in patients with an open ASD is higher at rest due to a left-to-right shunt, at peak exercise due to an additional increase in mPAP. A higher increase in afterload may affect RV function during exercise.
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