Serial exercise performance in children with surgically corrected congenital aortic stenosis

Area of Science:

• Pediatric Cardiology
• Exercise Physiology
• Congenital Heart Disease

Background:

• Congenital aortic stenosis (AS) is a significant condition in children.
• Management strategies include surgical intervention or conservative monitoring for mild to moderate cases.
• Exercise capacity is a key indicator of functional status in pediatric cardiac patients.

Purpose of the Study:

• To compare serial exercise test performance in surgically treated children with congenital AS versus nonoperated children with mild to moderate AS.
• To evaluate changes in exercise endurance and physiological responses over time in both groups.
• To assess the implications of exercise capacity for activity restrictions in pediatric AS patients.

Main Methods:

• Maximal treadmill exercise testing was performed on 21 postsurgical children (following Ross procedure or valvotomy/valvuloplasty) and 19 nonoperated children with AS (mean gradient <50 mmHg).
• Exercise data, including endurance time, heart rate, blood pressure, and ECG, were analyzed as repeated measures.
• Comparisons were made between initial and follow-up tests, and against age- and sex-matched normative data.

Main Results:

• Postsurgical children with AS exhibited normal endurance times and maintained them over follow-up, despite lower peak heart rates.
• Nonoperated children with AS also showed normal initial endurance and demonstrated improvement over time.
• Both operated and nonoperated pediatric AS groups achieved endurance times at or above normal levels.

Conclusions:

• Children with congenital AS, whether surgically treated or not, possess normal exercise endurance.
• The ability to achieve normal or supranormal endurance may challenge adherence to prescribed activity limitations.
• Serial exercise testing provides valuable insights into the functional capacity of pediatric AS patients over time.