[Evaluation of cardiorespiratory function in children and adolescents with repaired tetralogy of Fallot].
METHODS
To evaluate the cardiopulmonary exercise response of children and youngs operated upon for Tetralogy of Fallot (ToF) and to establish possible relationship with clinical and echocardiographic parameters we studied 24 pts, 14 males and 10 females, aged 14.5 +/- years; the age at repair was 5.2 +/- years and follow-up after correction was 8.6 +/- 3.2 years. All the pts were in NYHA functional class I; 8 pts had residual hemodynamic sequelae and 3 pts were on oral treatment. Cardiopulmonary exercise response with bicycle ergometer and incremental workload (25 watts/2 minutes), respiratory gas measurement with peak oxygen consumption (peak VO2) and ventilatory anaerobic threshold (VAT), were investigated in each patient. The data obtained were compared with those of control group of 103 healthy children and adolescents (59 males, 44 females, age 12.9 +/- 2.4 years) to the purpose of statistical analysis.


RESULTS
The series of operated ToF pts showed 15-20% reduction in cardio-respiratory parameters, compared to healthy controls. a) Pts operated after the age of 5 years showed a significant reduction in peak VO2 compared to those operated at an earlier age (21 +/- 3.4 vs 35.4 +/- 7.5, p = 0.001) with; b) inverse correlation between peak VO2 and age at operation (r = -0.5, p = 0.01); c) 8 pts with residual hemodynamic sequelae (pulmonary regurgitation and/or ventricular outflow obstruction) showed the worse cardio-pulmonary capacity (peak VO2 27.5 +/- 7 vs 36.1 +/-8.1, p<0.02; VAT 20.4 +/- 5.2 vs 29.5 +/- 4.4, p<0.02; d) a chronotropic limitation was also observed in the group of pts when compared to healthy controls (peak HR 177 +/- 17 vs 188 +/- 11, p<0.001).


CONCLUSIONS
Our study on pts operated upon for ToF showed a significant relation between age at surgery, hemodynamic sequelae and cardiopulmonary exercise response. Since this study has considered pts repaired in the two past decades, we believe that the present approach to ToF with early correction through atriotomy if possible and small outflow patch, may further improve the exercise capacity at a long-term follow-up.
Dall'Olio
M
M
Servizio di Cardiologia Pediatrica, Istituto di Malattie dell'Apparato Cardiovascolare, Università di Bologna.
Picchio
F M
FM
Specchia
S
S
Bonvicini
M
M
Magnani
B
B
D000293:Adolescent; D000328:Adult; D002319:Cardiovascular System / Q000503:physiopathology*; D016022:Case-Control Studies; D002648:Child; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D010101:Oxygen Consumption; D012137:Respiratory System / Q000503:physiopathology*; D013771:Tetralogy of Fallot / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D014463:Ultrasonography
Valutazione della capacità funzionale cardiorespiratoria in bambini e giovani operati per tetralogia di Fallot.