Skip to main content
Erschienen in: Pediatric Cardiology 2/2016

01.02.2016 | Original Article

Exercise Performance in Patients with D-Loop Transposition of the Great Arteries After Arterial Switch Operation: Long-Term Outcomes and Longitudinal Assessment

verfasst von: Joseph D. Kuebler, Ming-Hui Chen, Mark E. Alexander, Jonathan Rhodes

Erschienen in: Pediatric Cardiology | Ausgabe 2/2016

Einloggen, um Zugang zu erhalten

Abstract

The first patients to undergo a successful arterial switch operation (ASO) for d-transposition of the great arteries (D-TGA) are now entering their fourth decade of life. Past studies of ASO survivors’ exercise function have yielded conflicting results. We therefore undertook this study to describe the current function of ASO survivors, to identify factors related to inferior exercise performance and to determine whether their exercise function tends to deteriorate over time. A retrospective cohort study was designed examining all patients with D-TGA after the ASO who underwent comprehensive cardiopulmonary exercise testing (CPET). Patients with palliative surgery prior to ASO, ventricular hypoplasia or severe valvar dysfunction were excluded from the study. Data from CPETs in which the peak respiratory exchange ratio was <1.09 were also excluded. We identified 113 patients who met entry criteria and had 186 CPX at our institution between 1/2002 and 1/2013; 41 patients had at least 2 qualifying CPX. Mean age at the time of the initial test was 17 ± 1 year. Peak oxygen consumption (VO2) averaged 84 ± 2 % predicted. Peak VO2 was lower among patients with repaired ventricular septal defects (82 ± 4 vs. 86 ± 3 % predicted; p < 0.05) and among patients with ≥ moderate right-sided obstructive lesions (77 ± 5 vs. 87 ± 3 % predicted; p < 0.05). Surgery prior to 1991 was also associated with a lower peak VO2 (81 ± 3 vs. 87 ± 3 % predicted; p < 0.01). The mean % predicted peak heart rate was 92 ± 1 %, with no significant difference between any of the subgroups. Non-diagnostic exercise-induced STT changes developed in 10 patients (12 studies). In the subgroup with at least 2 exercise tests, the annual decline in % predicted peak VO2 was quite slow (−0.3 % points/year; p < 0.01 vs. expected normal age-related decline). The exercise capacity of ASO survivors is well preserved and is only mildly reduced compared to normal subjects. Moreover, there is only a slight deterioration in exercise capacity over time. VSD repair, residual right-sided obstructive lesions, and earlier surgical era are associated with worse exercise performance. Peak heart rate was preserved with no significant change in follow up testing.
Literatur
5.
17.
Zurück zum Zitat Ohuchi H, Ono S, Tanabe Y et al (2012) Long-term serial aerobic exercise capacity and hemodynamic properties in clinically and hemodynamically good, ‘excellent’, fontan survivors. Circ J 76:195–203. doi:10.1253/circj.CJ-11-0540 CrossRefPubMed Ohuchi H, Ono S, Tanabe Y et al (2012) Long-term serial aerobic exercise capacity and hemodynamic properties in clinically and hemodynamically good, ‘excellent’, fontan survivors. Circ J 76:195–203. doi:10.​1253/​circj.​CJ-11-0540 CrossRefPubMed
22.
Zurück zum Zitat Ruys TPE, van der Bosch AE, Cuypers JAAE et al (2013) Long-term outcome and quality of life after arterial switch operation: a prospective study with a historical comparison. Congenit Heart Dis 8:203–210. doi:10.1111/chd.12033 CrossRefPubMed Ruys TPE, van der Bosch AE, Cuypers JAAE et al (2013) Long-term outcome and quality of life after arterial switch operation: a prospective study with a historical comparison. Congenit Heart Dis 8:203–210. doi:10.​1111/​chd.​12033 CrossRefPubMed
23.
Zurück zum Zitat Singh TP, Wolfe RR, Sullivan NM et al (2001) Assessment of progressive changes in exercise performance in patients with a systemic right ventricle following the atrial switch repair. Pediatr Cardiol 22:210–214. doi:10.1007/s002460010205 CrossRefPubMed Singh TP, Wolfe RR, Sullivan NM et al (2001) Assessment of progressive changes in exercise performance in patients with a systemic right ventricle following the atrial switch repair. Pediatr Cardiol 22:210–214. doi:10.​1007/​s002460010205 CrossRefPubMed
Metadaten
Titel
Exercise Performance in Patients with D-Loop Transposition of the Great Arteries After Arterial Switch Operation: Long-Term Outcomes and Longitudinal Assessment
verfasst von
Joseph D. Kuebler
Ming-Hui Chen
Mark E. Alexander
Jonathan Rhodes
Publikationsdatum
01.02.2016
Verlag
Springer US
Erschienen in
Pediatric Cardiology / Ausgabe 2/2016
Print ISSN: 0172-0643
Elektronische ISSN: 1432-1971
DOI
https://doi.org/10.1007/s00246-015-1275-5

Weitere Artikel der Ausgabe 2/2016

Pediatric Cardiology 2/2016 Zur Ausgabe

Screening-Mammografie offenbart erhöhtes Herz-Kreislauf-Risiko

26.04.2024 Mammografie Nachrichten

Routinemäßige Mammografien helfen, Brustkrebs frühzeitig zu erkennen. Anhand der Röntgenuntersuchung lassen sich aber auch kardiovaskuläre Risikopatientinnen identifizieren. Als zuverlässiger Anhaltspunkt gilt die Verkalkung der Brustarterien.

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

25.04.2024 Hypotonie Nachrichten

Wenn unter einer medikamentösen Hochdrucktherapie der diastolische Blutdruck in den Keller geht, steigt das Risiko für schwere kardiovaskuläre Ereignisse: Darauf deutet eine Sekundäranalyse der SPRINT-Studie hin.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Adipositas-Medikament auch gegen Schlafapnoe wirksam

24.04.2024 Adipositas Nachrichten

Der als Antidiabetikum sowie zum Gewichtsmanagement zugelassene Wirkstoff Tirzepatid hat in Studien bei adipösen Patienten auch schlafbezogene Atmungsstörungen deutlich reduziert, informiert der Hersteller in einer Vorab-Meldung zum Studienausgang.

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.