title: Resting and exercise cardiorespiratory function in survivors of congenital diaphragmatic hernia.
abstract: Our objective was to study exercise capacity and cardiorespiratory response to exertion in survivors of congenital diaphragmatic hernia (CDH). This was a cross-sectional cohort study of 23 CDH survivors, aged 10-16 years, and 23 gender- and age-matched controls. Exercise testing was performed on a cycle ergometer, with cardiac output measurements made using exponential CO2 rebreathing. Pretest cardiorespiratory assessment was done by echocardiography and pulmonary function testing. Statistical analysis was performed using Student's t-test, regression analysis, and longitudinal model computing with spatial covariance structure. No echocardiographic evidence for pulmonary hypertension was found at rest (right ventricular systolic pressures, 27 +/- 6 mmHg). Mean pulmonary artery diameter on the side of the CDH was significantly smaller than contralaterally, but was within normal range (z-score, 0 +/- 1.1 vs. 1.2 +/- 1.6, P < 0.01). Exercise capacity was mildly reduced in CDH compared to controls and predictive data (maximum workload, 77% +/- 12% vs. 91% +/- 16% of predicted, P < 0.01). Cardiorespiratory response to exertion was not significantly different between groups. In conclusion, most adolescent CDH survivors have nearly normal exercise capacity and cardiorespiratory response to exertion. This study may prove useful in comparisons with future cohorts comprising more severely affected individuals now surviving due to improved neonatal care.
authors.affiliation: Division of Respiratory Medicine, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Daniel
authors.initials: D
authors.lastname: Trachsel
authors.forename: Hiran
authors.initials: H
authors.lastname: Selvadurai
authors.forename: Ian
authors.initials: I
authors.lastname: Adatia
authors.forename: Desmond
authors.initials: D
authors.lastname: Bohn
authors.forename: Jane
authors.initials: J
authors.lastname: Schneiderman-Walker
authors.forename: Donna
authors.initials: D
authors.lastname: Wilkes
authors.forename: Allan L
authors.initials: AL
authors.lastname: Coates
mesh_terms: D000293:Adolescent; D001837:Body Weights and Measures; D002302:Cardiac Output / Q000502:physiology; D002320:Cardiovascular Physiological Phenomena; D002648:Child; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005080:Exercise Test; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006339:Heart Rate / Q000502:physiology; D006548:Hernia, Diaphragmatic / Q000503:physiopathology*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D008176:Lung Volume Measurements; D008297:Male; D010101:Oxygen Consumption / Q000502:physiology; D011659:Pulmonary Gas Exchange / Q000502:physiology; D012115:Residual Volume / Q000502:physiology; D012129:Respiratory Function Tests; D012143:Respiratory Physiological Phenomena; D013318:Stroke Volume / Q000502:physiology; D017741:Survivors