title: Abnormal postexercise cardiovascular recovery and its determinants in patients after right ventricular outflow tract reconstruction.
abstract: BACKGROUND
  Abnormal responses of heart rate (HR) and oxygen uptake (VO2) during exercise characterize patients after right ventricular outflow tract reconstruction (RVOTR) for congenital heart defects. However, little is known about the postexercise dynamics.
  
  
  RESULTS
  We evaluated postexercise cardiovascular dynamics in 52 patients after closure of an atrioventricular septal defect (group A), 79 patients after RVOTR (group B), and 44 control subjects. HR variability, arterial baroreflex sensitivity (BRS), plasma norepinephrine, and hemodynamics were measured. Although there was no difference between group A and control subjects, declines in HR and VO2 after light and peak exercise and in systolic blood pressure (SBP) after peak exercise were delayed in group B. Age, low-frequency component of HR variability, and plasma norepinephrine were independent determinants of early HR decline. Peak SBP and VO2 had a great impact on the corresponding recoveries. When the peak values were excluded, body weight, BRS, and right ventricular ejection fraction were independent determinants of early SBP decline. BRS and the pulmonary artery resistance were independent determinants of VO2 decline throughout recovery, and age and right systolic ventricular pressure also determined the early VO2 decline. BRS and low-frequency component of HR variability were determined independently by the number of surgical procedures.
  
  
  CONCLUSIONS
  In RVOTR patients, in addition to metabolic and autonomic maturation, surgery-related abnormal cardiac autonomic nervous activity and impaired hemodynamics have a great impact on delayed postexercise cardiovascular recovery.
authors.affiliation: Department of Pediatrics, National Cardiovascular Center, Suita, Osaka, Japan. hohuchi@hsp.ncvc.go.jp
authors.forename: Hideo
authors.initials: H
authors.lastname: Ohuchi
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Ohashi
authors.forename: Jiksoo
authors.initials: J
authors.lastname: Park
authors.forename: Johji
authors.initials: J
authors.lastname: Hayashi
authors.forename: Aya
authors.initials: A
authors.lastname: Miyazaki
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Echigo
mesh_terms: D009320:Atrial Natriuretic Factor / Q000097:blood; D001341:Autonomic Nervous System / Q000502:physiology / Q000503:physiopathology; D017704:Baroreflex / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology; D001835:Body Weight; D006348:Cardiac Surgical Procedures; D002320:Cardiovascular Physiological Phenomena; D005080:Exercise Test; D006330:Heart Defects, Congenital / Q000503:physiopathology / Q000601:surgery*; D006339:Heart Rate / Q000502:physiology; D006343:Heart Septal Defects / Q000503:physiopathology / Q000601:surgery; D006352:Heart Ventricles / Q000601:surgery; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D016014:Linear Models; D020097:Natriuretic Peptide, Brain / Q000097:blood; D009638:Norepinephrine / Q000097:blood; D010101:Oxygen Consumption / Q000502:physiology; D011184:Postoperative Period; D020127:Recovery of Function / Q000502:physiology*; D012016:Reference Values; D012129:Respiratory Function Tests; D013318:Stroke Volume; D014694:Ventricular Outflow Obstruction / Q000503:physiopathology / Q000601:surgery
chemical_list: D020097:Natriuretic Peptide, Brain; D009320:Atrial Natriuretic Factor; D009638:Norepinephrine