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Dynamic exercise echocardiography in children with congenital heart disease affecting the left heart
E M Oyen1, G Ingerfeld, K Ignatzy
1Johanniter Kinderklinik, Department of Cardiology, Sankt Augustin, F.R.G.
Insights
Children with congenital heart disease and left ventricular overload show higher cardiac function during exercise. However, some cases indicate a diminished left ventricular reserve, suggesting potential limitations.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Physiology
- Echocardiography
Background:
- Congenital heart disease (CHD) can cause left ventricular (LV) volume and pressure overload.
- Assessing LV function during exercise is crucial for understanding adaptation in children with CHD.
Purpose of the Study:
- To evaluate LV function parameters in children with CHD-induced LV overload during supine bicycle exercise.
- To compare these parameters with those of healthy children.
Main Methods:
- Echocardiography, ECG, and phonocardiograms were used to measure LV function (FS, VcF, FScorr, VcFcorr) before, during, and after exercise.
- A protocol with increasing workload was employed.
- Data were compared between 35 children with CHD and 140 healthy controls.
Main Results:
- Children with LV pressure overload exhibited significantly higher FS, VcF, and frequency-corrected parameters than controls.
- Some children with severe aortic stenosis or coarctation showed decreased frequency-corrected parameters at high workloads, indicating diminished LV reserve.
- Post-aortic valve replacement, LV function parameters remained elevated.
- Hypertrophic cardiomyopathy patients had maximal rest values that did not increase with exercise.
- Mild volume overload cases showed normal or slightly below-normal LV function parameters.
Conclusions:
- Children with CHD and LV overload demonstrate enhanced systolic function at rest and during exercise.
- Diminished LV reserve can be identified by a decrease in frequency-corrected parameters at higher exercise levels.
- LV function assessment during exercise is valuable for evaluating CHD severity and response to treatment.
Abstract:
Thirty-five children (male 22, female 13) with congenital heart disease resulting in volume and pressure overload of the left ventricle were investigated echocardiographically during supine bicycle exercise. The children had to follow a test-protocol with increasing workload. Left ventricular function parameters were measured from M-mode-echocardiography, electrocardiography and phonocardiograms before, during and after exercise and were expressed as fractional shortening (FS), velocity of circumferential fiber shortening (VcF) and the frequency corrected parameters: FScorr. = FS X 100/HR and VcFcorr. = VcF X 100/HR (HR = heart rate). The data of this group of children under study were compared to those obtained from 140 healthy children examined under similar conditions. In children with pressure overload, values for fractional shortening, velocity of circumferential fiber shortening and the frequency corrected parameters were significantly higher than in normals throughout exercise testing. In some children with moderate to severe aortic stenosis or coarctation the frequency corrected parameters showed a decrease at higher exercise levels instead of an increase as seen in the majority of cases. In these cases cardiac output was increased by an abnormal rise in heart rate. This was considered as a diminished left ventricular reserve. After aortic valve replacement in two cases with aortic stenosis, parameters of left ventricular function were still elevated at rest and during exercise testing. In two children with hypertrophic cardiomyopathy the almost maximally elevated rest values did not change during exercise. In children with mild volume overload (small ventricular septal defect or aortic incompetence) the left ventricular function parameters were within the normal range or slightly below.