Exercise in patients with Tetralogy of Fallot: a tribute to the heart, lungs and muscles

Exercise capacity is used to evaluate cardiac function in patients with cardiac disease. Patients with Tetralogy of Fallot have a congenital heart defect that includes a ventricular septal defect, overriding aorta, pulmonary outflow tract stenosis and right ventricular hypertrophy. These patients require surgical repair, however, their hearts will not become completely normal after surgery and exercise limitations are previously described in adults. This thesis focusses on whether exercise limitations occur in childhood.

Exercise capacity increases during childhood and adolescence and will reach a maximum around the age of 25-30 years before it decreases. The ability to perform exercise depends on muscle mass and strength, oxygen transport by the cardiovascular system, and oxygen and carbon dioxide exchange in the lungs. The exercise capacity of children with Tetralogy of Fallot is 70-80% of healthy references. Results of cardiac adaptation to the abnormal loading conditions of the heart manifest during childhood and adolescence. At the same time, maximal muscle strength is reduced with near-normal motor skills and agility. Also, pulmonary function is reduced and mild pulmonary restriction occurs frequently in children with Tetralogy of Fallot. Pulmonary function and muscle strength might be affected by the abnormal preoperative circulation, and the impact of surgery and hospitalization(s) at young age might induce delayed neurodevelopment. Lack of physical activity possibly caused by a protective lifestyle further affects neuromuscular development, pulmonary function, exercise capacity, and self-reported quality of life.

Tailored treatment including lifestyle advice is essential to further enhance the lives of patients with congenital heart disease.

Dissertation: https://hdl.handle.net/11370/68fb7d6a-54f1-4779-9c0b-04f9a27d6d3e