How do patients with a repaired Tetralogy of Fallot or a Fontan circulation correspond to normal children and to each other when it comes to exercise and recovery.

Eshuis, G. (2014) How do patients with a repaired Tetralogy of Fallot or a Fontan circulation correspond to normal children and to each other when it comes to exercise and recovery. thesis, Medicine.

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Abstract

Introduction Improved survival rates in congenital heart diseases (CHD) lead to an increased morbidity in adult life. Morbidity is monitored by cardiopulmonary exercise testing (CPET). Particularly two patient groups are at risk for early exercise impairment: repaired tetralogy of Fallot (TOF) patients and Fontan patients. Aim To identify and describe maximal exercise capacity in children with repaired TOF and Fontan circulations. To assess whether the possible limitations are correlated to residual lesions, such as ventricular or valvular insufficiency. Materials and methods All participants (n = 87) underwent a maximal CPET in the period 2011-2013 in the University Medical Centre of Groningen. Seven patients were excluded due to submaximal exercise. The study population consisted of 11 healthy controls, 28 TOF patients and 41 Fontan patients. Cardiac function at rest was examined by echo and MRI assessments performed by medical experts. CPET protocol was a steep RAMP protocol on a cycle-ergometer. Exercise performance is defined as workload and maximum oxygen uptake (VO2 peak). Additional factors were monitored continuously: heart rate, ventilation, oxygen pulse, blood pressure and transcutaneous saturation. Results Exercise performance was significantly decreased in Fontan patients and seemed lower in TOF as compared to the control group. In Fontan and TOF maximal heart rate (HR max), chronotropic response to exercise, ventilation and ventilator efficiency were lower than in the controls. The oxygen pulse at peak exercise was also lower in the Fontan. Correlations between VO2 peak and BMI are found in both patients groups. In the Fontan group cardiac response to exercise was correlated to workload and VO2 peak. In the TOF children no additional parameters were correlated to exercise performance. Unexpectedly residual lesions and ventricular function was neither correlated to exercise capacity. Conclusion Fontan children are early impaired in their exercise performance, possibly due to reduced cardiac response to exercise. TOF children have a mildly reduced exercise capacity, although not yet explainable. Further studies are necessary to explain the role of heart rate recovery, ventilation capacity and muscle strength factors.

Item Type:	Thesis (Thesis)
Supervisor name:	Bartelds, Dr. B. and Berger, prof. dr. R.M.F. and Department of paediatric cardiology of the and Beatrix children’s hospital in Groningen.
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:57
Last Modified:	25 Jun 2020 10:57
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/1805

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