Hostname: page-component-cd9895bd7-dzt6s Total loading time: 0 Render date: 2024-12-23T11:51:38.771Z Has data issue: false hasContentIssue false
  • English
  • Français

Reduced long-term exercise capacity in young adults operated for ventricular septal defect

Published online by Cambridge University Press:  21 November 2013

Johan Heiberg ,
Sussie Laustsen ,
Annemette K. Petersen  and
Vibeke E. Hjortdal
Johan Heiberg*
Affiliation:
Department of Cardiothoracic & Vascular Surgery, Aarhus University Hospital, Aarhus N, Denmark
Sussie Laustsen
Affiliation:
Department of Physio- and Ergotherapy, Aarhus University Hospital, Aarhus N, Denmark
Annemette K. Petersen
Affiliation:
Department of Physio- and Ergotherapy, Aarhus University Hospital, Aarhus N, Denmark
Vibeke E. Hjortdal
Affiliation:
Department of Cardiothoracic & Vascular Surgery, Aarhus University Hospital, Aarhus N, Denmark
*
Correspondence to: Dr J. Heiberg, MD, Department of Cardiothoracic & Vascular Surgery, Aarhus University Hospital, Brendstrupgaardsvej 100, 8200 Aarhus N, Denmark. Tel: +4578453083; Fax: +4578453079; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Ventricular septal defects are normally closed in early childhood, and post-surgically the patients are considered as healthy and fit as their peers. However, data are inconsistent. We exercise-tested a cohort of ventricular septal defect-operated patients and a group of matched controls to evaluate long-term physical fitness.

Methods

Cardiopulmonary exercise capacity was tested on an ergometer cycle in 30 patients and 30 healthy age and gender-matched controls. Pulmonary ventilation and gas exchange were simultaneously measured breath-by-breath with Jaeger MasterScreen CPX® (CareFusion, San Diego, United States of America). During the test session, respiratory gas exchange was measured along with heart rate, blood pressure, and electrocardiogram. The endpoints were peak oxygen uptake, maximal workload, and ventilatory anaerobic threshold. The International Physical Activity Questionnaire and the SF-36 were applied for Health-Related Quality-of-Life assessment.

Results

Ventricular septal defect-operated adults had a markedly lower peak oxygen uptake: mean 38.0(±8.2 ml O2/kg/minute) versus 47.9(±6.5 ml O2/kg/minute) in controls, p<0.01. Furthermore, ventilatory anaerobic threshold was impaired in ventricular septal defect patients: mean 25.3(±7.8 ml O2/kg/minute) versus 35.2(±7.7 ml O2/kg/minute) in controls, p<0.01. Maximal workload was reduced: mean 3.3(±0.7 W/kg) versus 4.0(±0.5 W/kg) in the control group, p<0.01. Lastly, ventricular septal defect patients had a significantly lower peak heart rate: mean 182(±8.8 beats/minute) versus 188(±9.0 beats/minute) in controls, p=0.03. Regarding Health-Related Quality of Life, the ventricular septal defect group had significantly lower scores in physical functioning, role physical, and social functioning.

Conclusion

Young adults with a surgically closed ventricular septal defect had a markedly reduced cardiopulmonary exercise capacity and a lower peak heart rate compared with controls.

Keywords

Ventricular septal defectexercise testingpost-operative outcome
Type
Original Articles
Information
Cardiology in the Young , Volume 25 , Issue 2 , February 2015 , pp. 281 - 287
Copyright
Copyright © Cambridge University Press 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Marelli, AJ, Mackie, AS, Ionescu-Ittu, R, Rahme, E, Pilote, L. Congenital heart disease in the general population: Changing prevalence and age distribution. Circulation 2007; 115: 163–172.Google Scholar
2. Bol-Raap, G, Weerheim, J, Kappetein, AP, Witsenburg, M, Bogers, AJ. Follow-up after surgical closure of congenital ventricular septal defect. Eur J Cardiothorac Surg 2003; 24: 511–515.Google Scholar
3. Roos-Hesselink, JW, Meijboom, FJ, Spitaels, SE, et al. Outcome of patients after surgical closure of ventricular septal defect at young age: longitudinal follow-up of 22–34 years. Eur Heart J 2004; 25: 1057–1062.Google Scholar
4. Meijboom, F, Szatmari, A, Utens, E, et al. Long-term follow-up after closure of ventricular septal defect in infancy and childhood. J Am Coll Cardiol 1994; 24: 1358–1364.CrossRefGoogle ScholarPubMed
5. Norozi, K, Gravenhorst, V, Hobbiebrunken, E, Wessel, A. Normality of cardiopulmonary capacity in children operated on to correct congenital heart defects. Arch Pediatr Adolesc Med 2005; 159: 1063–1068.Google Scholar
6. Binkhorst, M, van de Belt, T, de Hoog, M, van Dijk, A, Schokking, M, Hopman, M. Exercise capacity and participation of children with a ventricular septal defect. Am J Cardiol 2008; 102: 1079–1084.CrossRefGoogle ScholarPubMed
7. Perrault, H, Drblik, SP, Montigny, M, et al. 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.CrossRefGoogle ScholarPubMed
8. Durmala, J, Rokicki, W, Kohut, J, Pilis, W. Physical fitness of children after operation of ventricular septal defect of the heart. Przegl lek 2002; 59: 984–986.Google Scholar
9. Reybrouck, T, Rogers, R, Weymans, M, et al. Serial cardiorespiratory exercise testing in patients with congenital heart disease. Eur J Pediatr 1995; 154: 801–806.Google Scholar
10. Beaver, LW, Wasserman, K, Whipp, BJ. A new method for detecting anaerobic threshold by gas exchange. J Appl Physiol 1986; 60: 2020–2027.CrossRefGoogle ScholarPubMed
11. Pedersen, TA, Ropcke, DM, Hjortdal, VE. Functional health status late after surgical correction of aortic coarctation. Congenit Heart Dis 2011; 6: 566–572.CrossRefGoogle ScholarPubMed
12. Kjoller, M, Rasmussen, NK, Keiding, LM. Self-reported health and morbidity among adult danes 1987–1994. Ugeskr laeger 1999; 161: 2948–2954.Google Scholar
13. Cumming, GR. Maximal exercise capacity of children with heart defects. Am J Cardiol 1978; 42: 613–619.Google Scholar
14. Driscoll, DJ, Wolfe, RR, Gersony, WM, et al. Cardiorespiratory responses to exercise of patients with aortic stenosis, pulmonary stenosis, and ventricular septal defect. Circulation 1993; 87: 102–113.Google ScholarPubMed
15. Cooper, DM, Weiler-Ravell, D, Whipp, BJ, Wasserman, K. Aerobic parameters of exercise as a function of body size during growth in children. J Appl Physiol 1984; 56: 628–634.Google Scholar
16. Norozi, K, Wessel, A, Alpers, V, et al. Chronotropic incompetence in adolescents and adults with congenital heart disease after cardiac surgery. J Card Fail 2007; 13: 263–268.Google Scholar
17. Katritsis, D, Camm, AJ. Chronotropic incompetence: a proposal for definition and diagnosis. Br Heart J 1993; 70: 400–402.Google Scholar
18. Tamer, D, Wolff, GS, Ferrer, P, et al. Hemodynamics and intracardiac conduction after operative repair of tetralogy of fallot. Am J Cardiol 1983; 51: 552–556.Google Scholar
19. Ohuchi, H, Watanabe, K, Kishiki, K, Wakisaka, Y, Echigo, S.. Heart rate dynamics during and after exercise in postoperative congenital heart disease patients. Their relation to cardiac autonomic nervous activity and intrinsic sinus node dysfunction. Am Heart J 2007; 154: 165–171.CrossRefGoogle ScholarPubMed
20. Bharati, S, Lev, M. Sequelae of atriotomy and ventriculotomy on the endocardium, conduction system and coronary arteries. Am J Cardiol 1982; 50: 580–587.CrossRefGoogle ScholarPubMed
21. Colucci, WS, Ribeiro, JP, Rocco, MB, et al. Impaired chronotropic response to exercise in patients with congestive heart failure. Role of postsynaptic beta-adrenergic desensitization. Circulation 1989; 80: 314–323.Google Scholar
22. Roche, F, Pichot, V, Da Costa, A, et al. Chronotropic incompetence response to exercise in congestive heart failure, relationship with the cardiac autonomic status. Clin Physiol 2001; 21: 335–342.Google Scholar
23. Möller, T, Brun, H, Fredriksen, PM, et al. Right ventricular systolic pressure response during exercise in adolescents born with atrial or ventricular septal defect. Am J Cardiol 2010; 105: 1610–1616.CrossRefGoogle ScholarPubMed