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European Heart Journal 2001 22(12):1052-1059; doi:10.1053/euhj.2000.2425
Copyright © 2001 by the European Society of Cardiology.
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Cardiorespiratory exercise function after the arterial switch operation for transposition of the great arteries

T Reybrouck, B Eyskens, L Mertens, J Defoor, W Daenen and M Gewilligf1

Departments of Congenital and Paediatric Cardiology and Cardiac Surgery, University Hospital Gasthuisberg, Belgium
Cardiovascular Rehabilitation Unit, Department of Rehabilitation Sciences, University of Leuven, Leuven, Belgium

revised August 22, 2000; accepted August 23, 2000

Abstract

Aims This study compares the functional outcome and cardiorespiratory response to exercise, in patients who have undergone arterial switch for transposition of the great arteries, with normal controls and patients who have undergone atrial switch operation.

Methods and Results Fifteen patients who had undergone arterial switch (mean age 8·5±2·9 years) were compared to 32 patients who had undergone atrial switch (9·2±1·8 years) and 27 normal controls (8·5±2·1 years). Exercise testing was performed on a treadmill and gas exchange measured breath-by-breath. Aerobic capacity, assessed by determination of the ventilatory anaerobic threshold, averaged 91±7·8% of normal (95% confidence limits: 92–108%) for arterial switch and 75·1±13·1% for atrial switch (P<0·001 patients vs normals). Aerobic exercise function was evaluated by calculation of the slope of oxygen uptake vs exercise intensity. The mean value for this slope was 2·0±0·25 for arterial switch, 2·5±0·46 for normals and 1·7±0·80 for atrial switch (P<0·05; patients vs normals). Efficiency of the pulmonary gas exchange was assessed by calculation of the slope of ventilation vs carbon dioxide output during exercise. This averaged 38·7±14·7 for arterial switch, 48·1±14·1 for atrial switch and 30·3±7·6 for normals (P<0·001; patients vs normals).

Conclusion Cardiorespiratory exercise function is at, or slightly below, the lower limit of normal in patients with arterial switch, while the lowest values were observed for those who had undergone atrial switch.

Key Words: Transposition great arteries • arterial switch, gas exchange, exercise testing

f1 Correspondence: Marc Gewillig, MD, PhD, Department of Paediatric Cardiology, University Hospital Gasthuisberg, Herestraat, 3000 Leuven, Belgium.

References

  1. Rigolin VH, Li JS, Hanson MW. Role of right ventricular and pulmonary functional abnormalities in limiting exercise capacity in adults with congenital heart disease. Am J Cardiol. 1997;80:315–322[CrossRef][Web of Science][Medline]
  2. Paul MH, Wessel HU. Exercise studies in patients with transposition of the great arteries after atrial repair operations (Mustard/Senning): A review. Pediatric Cardiology. 1999;20:49–55[CrossRef][Web of Science][Medline]
  3. Tanner JM, Whitehouse RH. Clinical longitudinal standards for height, weight, height velocity and weight velocity, and stages of puberty. Arch Dis Child. 1976;51:170–179[Abstract/Free Full Text]
  4. Reybrouck T, Mertens L, Brusselle S. Oxygen uptake versus exercise intensity: a new concept in assessing cardiovascular exercise function in patients with congenital heart disease. Heart. 2000;84:46–52[Abstract/Free Full Text]
  5. Reybrouck T, Mertens L, Kalis N. Dynamics of respiratory gas exchange during exercise after correction of congenital heart disease. J Appl Physiol. 1996;80:458–463[Abstract/Free Full Text]
  6. Washington RL, Bricker JT, Alpert BS. Guidelines for exercise testing in the pediatric age group. From the committee on atherosclerosis and hypertension in children, council on cardiovascular disease in the young,the American Heart Association. Circulation. 1994;90:2166–2179[Abstract/Free Full Text]
  7. Hughson RL, Northey DR, Xing HC, Dietrich BH, Cochrane JE. Alignment of ventilation and gas fraction for breath-by-breath respiratory gas exchange calculations in exercise. Comput Biom Res. 1991;24:118–128
  8. Eyskens D, Reybrouck T, Bogaert J. Homograft insertion for pulmonary regurgitation after repair of tetralogy of Fallot improves cardiorespiratory exercise performance. Am J Cardiol. 2000;85:221–225[CrossRef][Web of Science][Medline]
  9. Wessel, HU, Paul, MH, Stout, RL, Oxygen uptake response to progressive work rate increments of one and four minute duration in pediatric patients with congenital heart disease, Doye, EEEngle, MAGersony, WMAshkind, WJTalmon, NG, Pediatric Cardiology, New York, Springer Verlag, 1986, 246, 8
  10. Clark AI, Gatzoulis MA, Redington AN. Ventilatory responses to exercise in adults after repair of tetralogy of Fallot. Br Heart J. 1995;73:445–449[Abstract/Free Full Text]
  11. Beaver WL, Wasserman K, Whipp BJ. A new method for detecting anaerobic threshold by gas exchange. J Appl Physiol. 1986;60:2020–2027[Abstract/Free Full Text]
  12. Rogers DM, Olson BL, Wilmore JH. Scaling for the O2-to-body size relationship among children and adults. J Appl Physiol. 1995;79:958–967[Abstract/Free Full Text]
  13. Massin M, Hövels-Gürich H, Däbritz S, Messmer B, von Bernuth G. Results of the Bruce treadmill test in children after arterial switch operation for simple transposition of the great arteries. Am J Cardiol. 1998;81:56–60[CrossRef][Web of Science][Medline]
  14. Weindling SN, Wernovsky G, Colan SD. Myocardial perfusion, function and exercise tolerance after the arterial switch operation. J Am Coll Cardiol. 1994;23:424–433[Abstract]
  15. Martin RP, Qureshi SA, Ettedgui JA. An evaluation of right and left ventricular function after anatomical correction and intra-atrial repair operations for complete transposition of the great arteries. Circulation. 1990;82:808–816[Abstract/Free Full Text]
  16. Wasserman K, Zhang YY, Gitt A. Lung function and exercise gas exchange in chronic heart failure. Circulation. 1997;96:2221–2227[Abstract/Free Full Text]
  17. Myers J, Ashley E. Dangerous curves. A perspective on exercise, lactate, and the anaerobic threshold. Chest. 1997;111:787–795[Abstract/Free Full Text]
  18. Mocellin R, Gildein P. Velocity of oxygen uptake response at the onset of exercise: a comparison between children after corrective surgery and healthy boys. Pediatr Cardiol. 1999;20:17–20[CrossRef][Web of Science][Medline]
  19. Ohuchi H, Hiraumi Y, Tasato H. Comparison of the right and left ventricle as a systemic ventricle during exercise in patients with congenital heart disease. Am Heart J. 1999;137:1185–1194[CrossRef][Web of Science][Medline]
  20. Paridon SM, Humes RA, Pinsky WW. The role of chronotropic impairment during exercise after the Mustard operation. J Am Coll Cardiol. 1991;17:729–732[Abstract]
  21. Douard H, Labbé L, Barat JL, Broustet JP, Baudet E, Choussat A. Cardiorespiratory response to exercise after venous switch operation for transposition of the great Aarteries. Chest. 1997;111:23–29[Abstract/Free Full Text]
  22. Meijboom F, Szatmari A, Deckers JW. Long-term follow up (10–17 years) after Mustard repair for transposition of the great arteries. J Thorac Cardiovasc Surg. 1996;111:1158–1168[Abstract/Free Full Text]
  23. Bowyer JJ, Busst CM, Till JA, Lincoln C, Shinbourne EA. Exercise ability after Mustard's operation. Arch Dis Child. 1990;65:865–870[Abstract/Free Full Text]
  24. Perrault H, Drblik SP, Montigny M. Comparison of cardiovascular adjustments to exercise in adolescents 8 to 15 years of age after correction of tetralogy of Fallot, ventricular septal defect or atrial septal defect. Am J Cardiol. 1989;64:213–217[CrossRef][Web of Science][Medline]
  25. Reybrouck T, Weymans M, Stijns H, Van der Hauwaert LG. Exercise testing after correction of tetralogy of Fallot: the fallacy of a reduced heart rate response. Am Heart J. 1986;112:998–1003[CrossRef][Web of Science][Medline]
  26. Wessel HU, Cunningham WJ, Paul MH, Bastanier CK, Muster AJ, Idriss FS. Exercise performance in tetralogy of Fallot after intracardiac repair. J Thorac Cardiovasc Surg. 1980;80:582[Abstract]
  27. Reybrouck T, Bisschop A, Dumoulin M, Van der Hauwaert LG. Cardiorespiratory exercise capacity after surgical closure of atrial septal defect is influenced by the age at surgery. Am Heart J. 1991;122:1073–1078[CrossRef][Web of Science][Medline]
  28. Sarkar D, Bull C, Yates R. Comparison of long-term outcomes of atrial repair of simple transposition with implications for a late arterial switch strategy. Circulation. 1999;100:176–181
  29. Turina MI, Siebenmann R, Von Sogesser L, Schönbeck M, Senning A. Late functional deterioration after atrial correction for transposition of the great arteries. Circulation. 1989;80:1162–1167
  30. Gilljam T, Eriksson O, Sixt R. Cardiac output and pulmonary gas exchange at maximal exercise after atrial redirection for complete transposition. Eur Heart J. 1998;19:1856–1864[Abstract/Free Full Text]
  31. Francis DP, Shamin W, Ceri Davies L. Cardiopulmonary exercise testing for prognosis in chronic heart failure: continuous and independent prognostic value from E/CO2. Eur Heart J. 2000;21:154–161[Abstract/Free Full Text]
  32. Habedank D, Reindl I, Vietzke G. Ventilatory efficiency and exercise tolerance in 101 healthy volunteers. Eur J Appl Physiol. 1998;77:421–426

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