Copyright © 1998 by the European Society of Cardiology.
Cardiac output and pulmonary gas exchange at maximal exercise after atrial redirection for complete transposition
a Division of Paediatric Cardiology, Department of Paediatrics, Sahlgrenska University Hospital, Göteborg, Sweden
b Department of Paediatric Clinical Physiology, Sahlgrenska University Hospital, Göteborg, Sweden
accepted May 27, 1998
Aims
To assess the determinants of exercise capacity and exercise oxygenation after atrial redirection for complete transposition.
Methods and Results
At graded bicycle ergometry, including respiratory and arterial blood gas analyses, intra-arterial blood pressure recording, and cardiac output determination (dye-dilution technique), we tested 17 post-Mustard/Senning patients, 8·9–22·0 years old (mean 14·5, SD4·0). Reference data were obtained by similar methods. At maximal exercise, oxygen uptake (29·6ml.kg–1.min–1) and heart rate (167 beats.min–1) were low (P<0·001). Right-to-left shunts were detected in five patients. Arterial oxygen partial pressure and satu-ration fell in all subjects (P<0·0001). In 15/16 (94%) the alveolar–arterial oxygen partial pressure difference was >+2SD. In 13/15 (87%) stroke volumes fell during exercise. Cardiac output per oxygen uptake was low (P<0·0001), which implies a high arteriovenous oxygen difference and a low mixed venous oxygen content at peak exercise.
Conclusion
The low exercise capacity was caused by a combination of low maximally attained heart rate and falling stroke volumes. The impaired arterial oxygenation may be caused by a combination of pulmonary ventilation/perfusion mismatch, a low mixed venous content and atrial shunting in some patients.
Key Words: Mustard operation, Senning operation, cardiac output, exercise test, gas exchange.
f1 Correspondence: Dr T. Gilljam, Department of Cardiology, The Hospital for Sick Children, Toronto, Ont, Canada M5G 1X8.
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