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The Journal of Thoracic and Cardiovascular Surgery, Vol 80, 582-593, Copyright © 1980 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
HU Wessel, WJ Cunningham, MH Paul, CK Bastanier, AJ Muster and FS Idriss
We evaluated 99 male and 36 female patients with tetralogy of Fallot 1 year
or more after intracardiac repair (ICR) in 279 exercise studies between
1968 and 1979. Sixty tetralogy patients were studied serially two to nine
times at 12 to 18 month intervals. Work performance and heart rate response
to cycle exercise with stepwise loading (100 kg- m/min increments) were (1)
related to clinical, pre- and post-ICR cardiac catheterization, surgical,
and anatomic information and (2) compared to results obtained in 221 male
and 157 female normal control volunteers. On the average, male tetralogy
patients were shorter and weighed less than control subjects, but female
tetralogy patients as a group showed no growth impairment. Many tetralogy
patients had slower resting, submaximal, and final exercise heart rates
than did control subjects. Work performance averaged 82% +/- 21% of
predicted in male patients and 86% +/- 29% in female patients. Serial
studies showed no significant changes in work performance in the majority
of tetralogy patients for up to 10 years. Best work performance was found
in nine varsity athletes (99% +/- 22%) and 21 patients with primar ICR (94%
+/- 23%). Statistical analysis demonstrated a significant relationship
between reduced work performance and residual disease, notably cardiac
enlargement, increased peak systolic right ventricular pressure, pulmonic
valve incompetence (PI), residual ventricular septal defect (VSD),
pulmonary hypertension, and cardiac rhythm disturbances. However, in
individuals work performance cannot be predicted reliably from the presence
of these lesions and should therefore be measured. We conclude that
exercise testing is a useful adjunct to the clinical and hemodynamic
evaluation of post-ICR tetralogy.
ARTICLES
Exercise performance in tetralogy of Fallot after intracardiac repair
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