title: Comparison of the Degree of Exercise Tolerance in Children After Surgical Treatment of Complex Cardiac Defects, Assessed Using Ergospirometry and the Level of Brain Natriuretic Peptide.
abstract: Children who underwent surgery for complex congenital heart defects present worse exercise capacity than their healthy peers. In adults and adolescents, heart failure is assessed on the basis of clinical symptoms using the New York Heart Association (NYHA) score, while in an infant Ross scale; heart failure can also be evaluated by other parameters. The purpose of this study was to compare the degree of exercise tolerance in children after surgery for complex heart defects, assessed by the ratio of maximum oxygen uptake (VO2max) and the brain natriuretic peptide (N-terminal fragment of the prohormone brain-type natriuretic peptide [NT-proBNP]) concentration.The study group consisted of 42 children, ages 9 to 17 years (mean 14.00 ± 2.72). Among them there were 22 children with tetralogy of Fallot (ToF) after total correction, 18 children with transposition of the great arteries (d-TGA) after the arterial switch operation, and 2 children with single ventricle (SV) after the Fontan operation. All but 1 child were in NYHA class I. The control group consisted of 20 healthy children. Outcomes of interest were the ratio of VO2max, determined during ergospirometry, and the level of NT-proBNP. The statistical analysis was performed and the groups were considered significantly different for P < 0.05.There was no statistically significant correlation between NT-proBNP and maximum oxygen uptake (VO2) kg min in the study group compared with the control group.The VO2max in the test group had a mean value less (34.6 ± 8.0) than controls (38.4 ± 7.7), and the differences were statistically significant (P = 0.041). In contrast, the average concentration of NT-proBNP in the study group was higher than controls (117.9 ± 74.3 vs 18.0 ± 24.5), and these differences were statistically significant (P < 0.001).After operations for complex heart defects (ToF, TGA, and SV), children have worse heart function parameters and exercise capacity than the healthy population. To control this, we recommend postoperative ergospirometry and determination of NT-proBNP concentrations.
authors.affiliation: From the Department of Pediatrics Cardiology, School of Medicine (BM, LS, JP) and Department of Nursing and Social Medical Problems Chair of Nursing, School of Health Sciences (GM-L), Medical University of Silesia, Katowice, Poland; Upper Silesian Center of Children's Health, Katowice (MM); Department of Pediatric Cardiosurgery and Cardiosurgical Intensive Care University Children Hospital, Faculty of Medicine and Faculty of Health Sciences Jagiellonian University Medical College, Krakow, Poland (AM); and Faculty of Medicine, Department of Pediatric Cardiosurgery, Polish-American Institute of Pediatrics, and Faculty of Health Sciences, Jagiellonian University Medical College (AM), Krakow, Poland.
authors.forename: Boguslaw
authors.initials: B
authors.lastname: Mazurek
authors.forename: Leslaw
authors.initials: L
authors.lastname: Szydlowski
authors.forename: Magdalena
authors.initials: M
authors.lastname: Mazurek
authors.forename: Grazyna
authors.initials: G
authors.lastname: Markiewicz-Loskot
authors.forename: Jacek
authors.initials: J
authors.lastname: Pajak
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Morka
mesh_terms: D000293:Adolescent; D006348:Cardiac Surgical Procedures; D002648:Child; D005080:Exercise Test / Q000379:methods*; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D006330:Heart Defects, Congenital / Q000503:physiopathology* / Q000601:surgery*; D006333:Heart Failure / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010101:Oxygen Consumption / Q000502:physiology; D010446:Peptide Fragments / Q000097:blood*; D011183:Postoperative Complications; D013147:Spirometry
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain