title: Pulmonary limitation to exercise after repair of D-transposition of the great vessels: atrial baffle versus arterial switch.
abstract: This study evaluated resting pulmonary function and its impact on exercise capacity after atrial baffle (BAFFLE) and arterial switch (SWITCH) repair of D-transposition of the great vessels (DTGV). Previously decreased exercise capacity in DTGV patients has been primarily attributed to cardiovascular limitations, whereas pulmonary limitations have largely been overlooked. Resting flow volume loops were compared for BAFFLE (n = 34) and SWITCH (n = 32) patients. Peak exercise variables were compared for BAFFLE (n = 30) and SWITCH (n = 25). Lung disease (restrictive and/or obstructive) was present in 53% of DTGV patients (BAFFLE 62% and SWITCH 44%; p = 0.14). BAFFLE patients had a normal breathing reserve, whereas that of SWITCH patients was decreased (27.3 ± 28.3 vs. 13.0 ± 19.2; p = 0.04). BAFFLE patients attained a lower percent of predicted peak oxygen pulse (82.7 ± 20.5% vs. 94.7 ± 19.3%; p = 0.04) and peak oxygen consumption (VO(2peak)) (26.6 ± 6.7 ml/kg/min vs. 37.3 ± 8.5 ml/kg/min; p < 0.01) than SWITCH patients. Patients after surgical repair for DTGV have an underappreciated occurrence of lung disease, even post-SWITCH. SWITCH patients have diminished breathing reserves, suggesting a pulmonary limitation to VO(2peak). BAFFLE patients have lower VO(2peaks), greater breathing reserves, and lower oxygen pulses than SWITCH patients, suggesting a cardiac limitation to peak aerobic capacity with probable secondary pulmonary limitations. Treating underlying lung disease in symptomatic patients after repair of DTGV may improve functional status.
authors.affiliation: Department of Pediatric Cardiology, Riley Hospital for Children at Indiana University Center, 702 Barnhill Drive, RR 127, Indianapolis, IN 46202-5225, USA. lsterret@iupui.edu
authors.forename: Lauren E
authors.initials: LE
authors.lastname: Sterrett
authors.forename: Eric S
authors.initials: ES
authors.lastname: Ebenroth
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Montgomery
authors.forename: Marcus S
authors.initials: MS
authors.lastname: Schamberger
authors.forename: Roger A
authors.initials: RA
authors.lastname: Hurwitz
mesh_terms: D000293:Adolescent; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002648:Child; D003331:Coronary Vessels / Q000601:surgery*; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008168:Lung / Q000503:physiopathology; D008297:Male; D010101:Oxygen Consumption; D011184:Postoperative Period; D011651:Pulmonary Artery / Q000601:surgery*; D012129:Respiratory Function Tests / Q000379:methods*; D012189:Retrospective Studies; D014188:Transposition of Great Vessels / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult