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Long-term assessment and serial evaluation of cardiorespiratory exercise performance and cardiac function in patients with atrial switch operation for complete transposition

Published online by Cambridge University Press:  01 July 2011

Tony Reybrouck ,
Luc Mertens ,
Steven Brown ,
Benedicte Eyskens ,
Willem Daenen  and
Marc Gewillig
Tony Reybrouck
Affiliation:
Cardiovascular Rehabilitation, University Hospital Gasthuisberg, Belgium Department of Rehabilitation Sciences, University of Leuven, Belgium
Luc Mertens
Affiliation:
Departments of Congenital and Paediatric Cardiology, University Hospital Gasthuisberg, Belgium
Steven Brown
Affiliation:
Departments of Congenital and Paediatric Cardiology, University Hospital Gasthuisberg, Belgium
Benedicte Eyskens
Affiliation:
Departments of Congenital and Paediatric Cardiology, University Hospital Gasthuisberg, Belgium
Willem Daenen
Affiliation:
Cardiac Surgery, University Hospital Gasthuisberg, Belgium
Marc Gewillig*
Affiliation:
Departments of Congenital and Paediatric Cardiology, University Hospital Gasthuisberg, Belgium
*
Correspondence to: Marc Gewillig MD, Department of Paediatric Cardiology, University Hospital Gasthuisberg, Herestraat, 3000 Leuven, Belgium. Tel: 32 16 343865; Fax: 32 16 343982; E-mail: marc.gewillig@med.kuleuven.ac.be
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Abstract

Background: At present, a considerable number of patients survive who underwent an atrial switch operation for correction of complete transposition. Our study aimed to assess their long-term exercise performance and the serial evolution of cardiac function. Methods: We studied 22 patients 5 to 17 years after an atrial switch operation, and followed them serially for 3.5 ± 2 years after the first evaluation. Cardiorespiratory exercise function was assessed by analysis of gas exhange and by determination of the ventilatory anaerobic threshold. Echocardiography was performed on all evaluations. Results: All patients were in Class I of the classification of the New York Heart Association at all assessments. Ventilatory anaerobic threshold, however, was significantly lower than normal. It averaged 77.9% ± 13.7 of the normal mean value at the initial evaluation, and remained stable when re-evaluated later (76.2 ± 13.7%). At the initial study, the increase in oxygen uptake during graded exercise was below the 95% confidence limit in 6 of the patients, and was below this level in 10 patients at re-assessment. The subnormal values for oxygen uptake during submaximal exercise were associated with moderate to severe haemodynamic dysfunction. At echocardiography, 15 of 17 patients studied twice had mild to moderate right ventricular dilation and tricuspidregurgiation, which remained virtually the same at reasssesment. A stable sinus rhythm was initially present in 17 patients, and persisted in 15 patients during follow-up. Conclusion: At medium term follow-up, cardiorespiratory exercise performance remains stable in patients after atrial switch repair. Serial exercise testing appears useful, because in individual patients in the present study, a decreasing exercise tolerance correlated with development of haemodynamic sequels.

Keywords

Discordant ventriculo-arterial connectionsexercise testingMustard operationSenning operationpulmonary gas exchange.
Type
Original Articles
Information
Cardiology in the Young , Volume 11 , Issue 1 , January 2001 , pp. 17 - 24
Copyright
Copyright © Cambridge University Press 2001

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