title: Cardiac rehabilitation in a pediatric patient with heart retransplantation. A single case study.
abstract: BACKGROUND
  Cardiac rehabilitation (CR) after heart transplantation is known to benefit physical capacity in adults, but the advantages of CR on pediatric patients with heart retransplantation remain undetermined.
  
  
  OBJECTIVE
  The purpose of the present study was to report the effect of structured CR for a boy receiving heart transplantations twice.
  
  
  METHODS
  Single case study.
  
  
  METHODS
  Inpatient and outpatient rehabilitation department.
  
  
  METHODS
  A pediatric patient underwent heart transplantation due to dilated cardiomyopathy at 13.6 year-old and retransplantation owing to severe cardiac allograft vasculopathy at 16.2 year-old.
  
  
  METHODS
  CR was arranged after both transplantations. Bicycle or treadmill exercises were conducted three times weekly with the intensity adjusted to the ventilatory threshold. Serial cardiopulmonary exercise tests were performed to evaluate the sequential cardiorespiratory function changes using the peak oxygen uptake (VO₂peak) as the primary outcome.
  
  
  RESULTS
  The patient had undergone 10 times of exercise tests during rehabilitation. The VO₂peak increased from 12.27 to 15.63 mL·kg-1·min-1 within 6 months after the primary transplantation. However, the VO₂peak dropped intensively after a rejection episode and failed to improve since the development of cardiac allograft vasculopathy. Following retransplantation, the VO₂peak appeared worse initially but increased gradually with rehabilitation. One year subsequent to retransplantation, the VO₂peak reached 17.7 mL·kg-1·min-1 with a 7.22 mL·kg-1·min-1 improvement compared with his baseline value.
  
  
  CONCLUSIONS
  Structured CR improves aerobic capacity of a pediatric patient with heart retransplantation.
  
  
  CONCLUSIONS
  CR is safe and beneficial for pediatrics with heart retransplantation. Cardiopulmonary exercise testing can be considered as an adjuvant tool for detecting rejection or cardiac allograft vasculopathy in pediatric heart transplantation recipients.
authors.forename: K-V
authors.initials: KV
authors.lastname: Chang
authors.forename: H-H
authors.initials: HH
authors.lastname: Chiu
authors.forename: S-S
authors.initials: SS
authors.lastname: Wang
authors.forename: C
authors.initials: C
authors.lastname: Lan
authors.forename: S-Y
authors.initials: SY
authors.lastname: Chen
authors.forename: N-K
authors.initials: NK
authors.lastname: Chou
authors.forename: M-H
authors.initials: MH
authors.lastname: Wu
authors.forename: J-S
authors.initials: JS
authors.lastname: Lai
mesh_terms: D000293:Adolescent; D000328:Adult; D002311:Cardiomyopathy, Dilated / Q000503:physiopathology / Q000534:rehabilitation / Q000601:surgery*; D005081:Exercise Therapy / Q000379:methods*; D017079:Exercise Tolerance; D016027:Heart Transplantation / Q000534:rehabilitation*; D006801:Humans; D008297:Male