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Published on: February 9, 2016
Results of exercise testing at a mean age of 10 years after neonatal arterial switch operation
H H Hövels-Gürich1, D Kunz, M- C Seghaye
1Department of Paediatric Cardiology, University Hospital, Aachen University of Technology, Aachen, Germany. hhoevels-guerich@ukaachen.de
Insights
Children who underwent arterial switch operation for transposition of the great arteries show excellent long-term exercise capacity. Exercise testing is a valuable tool for monitoring these young patients.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Surgical Outcomes
Background:
- Transposition of the great arteries is a critical congenital heart defect.
- Neonatal arterial switch operation (ASO) is the standard surgical repair.
- Long-term functional outcomes, particularly exercise capacity, require further investigation.
Purpose of the Study:
- To evaluate long-term exercise capacity in children following neonatal ASO.
- To assess electrocardiographic (ECG) response and myocardial injury markers during exercise.
- To compare exercise parameters with age-matched healthy children.
Main Methods:
- Prospective follow-up study of 56 asymptomatic children (mean age 10 years) post-ASO.
- Bruce treadmill test to assess exercise tolerance.
- ECG, echocardiography, and serial blood markers (cardiac troponin I/T, CK, myoglobin) were analyzed.
Main Results:
- 96.4% of patients demonstrated normal exercise capacity.
- Heart rate and systolic blood pressure responses were comparable to controls; diastolic pressure was lower.
- ECG and myocardial injury markers remained normal in all patients post-exercise.
Conclusions:
- Neonatal ASO is associated with excellent long-term exercise capacity.
- Exercise testing is a safe and effective non-invasive screening method.
- Routine exercise testing can identify potential exercise-induced myocardial ischemia in growing patients.
Aim:
This prospective follow-up study investigated long-term exercise capacity at a mean age of 10 y after neonatal arterial switch operation for transposition of the great arteries in a large group of homogeneous unselected children.
Methods:
56 asymptomatic children, aged 7.9-14.3 y (10.5 +/- 1.6, mean +/- SD), were examined with respect to exercise tolerance, electrocardiographic (ECG) response and activity of biochemical markers for myocardial injury. The protocol included standard electrocardiography, M-mode and two-dimensional echocardiography at rest, a Bruce walking treadmill test to voluntary exhaustion, and determination of cardiac troponin I and T, creatine kinase and myoglobin from venous blood samples at rest and 4 h after exercise. Heart rate, blood-pressure response to exercise stress and endurance time were compared with published results of age-matched normal children.
Results:
54 patients (96.4%) had normal exercise capacity; a reduction in 2 patients was not due to cardiac disease. Heart rate and systolic blood pressure rose significantly between rest and peak exercise and did not differ from normal controls, whereas diastolic blood pressure was lower. ECG remained normal at rest and on exercise in 54 children (96.4%). Serum values of cardiac troponin I and T, creatine kinase and myoglobin were normal at rest and after exercise in all patients.
Conclusion:
The study demonstrates excellent long-term exercise capacity after neonatal arterial switch operation. Exercise testing is a useful and non-invasive screening method to detect patients with clinically relevant exercise-induced myocardial ischaemia and should be routinely performed in growing patients.
