Exercise training improves activity in adolescents with congenital heart disease Six-minute walking test to assess exercise tolerance and cardiorespiratory responses during training program in children with congenital heart disease. Design and rationale for the PREVAIL study: effect of e-Health individually tailored encouragements to physical exercise on aerobic fitness among adolescents with congenital heart disease--a randomized clinical trial. Efficacy of exercise training in pulmonary arterial hypertension associated with congenital heart disease. The diagnostic and prognostic value of brain natriuretic peptides in adults with a systemic morphologically right ventricle or Fontan-type circulation. Failure of remote ischemic preconditioning to reduce the risk of postoperative acute kidney injury in children undergoing operation for complex congenital heart disease: a randomized single-center study. Marked changes in platelet count and function following pediatric congenital heart surgery.
Objectives To ascertain if motivational techniques and a structured exercise programme can increase activity in adolescents afflicted with congenital heart disease ( CHD ) . Design Prospect i ve r and omised controlled trial . Setting One hundred and forty-three patients aged 12–20 years attending the tertiary centre for paediatric cardiology in Northern Irel and . Main outcome measures Increase in exercise capacity as assessed by duration of exercise stress test , and number of minutes spent in moderate to vigorous physical activity ( MVPA ) per day . Results Eighty-six patients were men ( 60 % ) , mean age was 15.60±2.27 years . Seventy-three percent were considered to have major CHD . Seventy-two participants were r and omised to the intervention group . Following intervention , duration of exercise test increased by 1 min 5 s for the intervention group ( p value 0.02 ) along with increase in predicted VO2Max ( p value 0.02 ) . There was a significant increase in minutes of MVPA per day for the intervention group from baseline to re assessment ( p value < 0.001 ) while MVPA remained much the same for the control group . Fourteen patients met the current recommendation for more than 60 min MVPA per day at baseline . This doubled to 29 participants at re assessment . There were no adverse effects or mortalities reported . Conclusions Exercise training  is safe , feasible and beneficial in adolescents with CHD . Psychological techniques can be employed to maximise the impact of interventions . Trial Registration Number IS RCT N27986270 This study assessed the exercise tolerance and the cardiorespiratory responses to a training program by the six-minute walk test ( 6'WT ) in children with congenital heart disease ( CHD ) . Seventeen cardiac and 14 healthy children performed maximal cardiopulmonary exercise test ( CPET ) and 6'WT . Reliability of 6'WT was assessed in all subjects ( test-retest ) by Bl and -Altman plots . Cardiac subjects were r and omly divided in training ( T-CHD ) and control groups ( C-CHD ) . T-CHD underwent an individualized training exercise at the ventilatory threshold ( VT ) intensity during 12 weeks . We found that the 6'WT is a reliable and reproducible test . CHD children  walked a lower distance than healthy children before training ( 472.5 + /- 18.1 vs. 548.8 + /- 7.7 m , respectively , p < 0.001 ) . Likewise , power output , oxygen uptake ( V.O ( 2 ) ) , and heart rate ( HR ) at the maximum and the VT levels , were significantly lower in patients ( p < 0.001 ) . After training , a significant improvement of walking distance ( WD ) was shown in T-CHD ( 529.6 + /- 15.3 vs. 467.7 + /- 17.1 m , p < 0.001 ) . The power output , VO2 , HR , and V.E increased slightly ( 6 to 10 % , p > 0.05 ) at peak exercise and significantly at ventilatory threshold level ( p < 0.05 ) in T-CHD . Significant relationships between WD and VO2max as well as VO2 at VT were founded ( p < 0.05 ) . We concluded that the 6'WT is a useful and reliable tool in the assessment and follow-up of functional capacity during rehabilitation program in children with CHD Intensive exercise may be an important part of rehabilitation in patients with congenital heart disease ( CHD ) . However , performing regular physical exercise is challenging for many adolescent patients . Consequently , effective exercise encouragements may be needed . Little is known on the effect of e-Health encouragements on physical fitness , physical activity , and health-related quality of life in adolescents . This trial is a nationwide interactive e-Health rehabilitation study lasting 1 year , centered on interactive use of mobile phone and Internet technology . We hypothesize that e-Health encouragements and interactive monitoring of intensive exercise for 1 year can improve physical fitness , physical activity , and health-related quality of life .  Two hundred sixteen adolescents ( age , 13 - 16 years ) with surgically corrected complex CHD but without significant hemodynamic residual defects and no restrictions to participate in physical activity are in the process of being enrolled by invitation after informed consent . Physical fitness is measured as the maximal oxygen uptake ( Vo(2 ) ) at baseline and after 12 months by an assessor blinded to the r and omization group . After baseline testing , the patients are 1:1 r and omized to an intervention group or a control group . Individually fully automated tailored e-Health encouragements -- SMS , Internet , and mobile applications--  aim ed at increasing physical activity  are delivered to the participants in the intervention group once a week . The B and ura 's Social Cognitive Theory inspires the behavioral theoretical background . The e-Health intervention and the Godfrey cycle ergometer protocol have been feasibility tested and seem applicable to adolescents with CHD . The trial is expected to contribute with new knowledge regarding how physical activity in adolescents with CHD can be increased and , possibly , comorbidity be reduced BACKGROUND The objective of this prospect i ve study was to assess the efficacy of exercise training as add-on to medical therapy in patients with congenital heart disease associated pulmonary arterial hypertension ( CHD-APAH ) . METHODS Patients with invasively confirmed CHD-APAH received in-hospital exercise training for 3 weeks and continued at home . Efficacy parameters were evaluated at baseline , after 3 and 15 weeks . Medical treatment remained unchanged . Worsening events and survival rate were assessed in a follow-up period of 21 ± 14 months . RESULTS Twenty consecutive CHD-APAH patients ( 16 female , 4 male , mean pulmonary arterial pressure 60 ± 23 mm Hg ) were included . Patients significantly improved the mean distance walked in 6 min compared to baseline by 63 ± 47 m after 3 weeks ( p<0.001 ) and by 67 ± 59 m after 15 weeks ( p=0.001 ) . Quality of life-score ( p=0.05 ) , peak oxygen consumption ( p=0.002 ) and maximal workload ( p=0.003 ) improved significantly by exercise training after 15 weeks . The 1- and 2-year survival rates were 100 % , the transplantation-free survival rate was 100 % after 1 year and 93 % after 2 years . CONCLUSION Exercise training as add-on to medical therapy may be effective in patients with CHD-APAH and improved work capacity , quality of life and further prognostic relevant parameters . It was associated with an excellent long-term survival . Further r and omized controlled studies are needed to confirm these results BACKGROUND In acquired heart disease , brain natriuretic peptide ( BNP ) and N-Terminal pro-brain natriuretic peptide ( NT-proBNP ) are increasingly used as diagnostic and prognostic markers . In adult congenital heart disease , the abnormal anatomy and physiology complicate assessment of cardiac function . We studied the clinical correlates of measurement of natriuretic peptides ( NP ) in adults with a right ventricle in the systemic position or with Fontan-type physiology . METHODS A prospect i ve longitudinal study ( follow up time 23+/-13 months , mean+/-S.D. ) was conducted in a specialised centre on 61 patients ( age 26+/-8 years ; NYHA class 1.5+/-0.6 ) including Senning/Mustard corrected transposition , congenitally corrected transposition and Fontan/total cavopulmonary connection .  Plasma NP concentration was compared with NYHA class , exercise capacity and echocardiographically determined systemic systolic ventricular function . RESULTS Neurohormone concentrations were generally elevated ( mean=290 % of upper reference limit ) and related to NYHA class ( P<0.001 , NYHA I vs. II-IV ) . No clinical ly significant relationship to ventricular function or exercise capacity was found however . An NP measurement could not predict the future course of the disease in terms of functional status or ventricular function . CONCLUSION In contrast to patients with acquired heart disease , measurement of NP seems to have low clinical value in adults with a right ventricle in the systemic position or with Fontan-type physiology OBJECTIVE The objective of this study was to evaluate whether remote ischemic preconditioning can protect kidney function in children undergoing operation for complex congenital heart disease . METHODS Children ( n = 113 ) aged 0 to 15 years admitted for complex congenital heart disease were r and omly allocated according to age to remote ischemic preconditioning and control groups . After exclusion of 8 patients , we conducted the analysis on 105 patients ( remote ischemic preconditioning group , n = 54 ; control group , n = 51 ) . Before surgery , remote ischemic preconditioning was performed as 4 cycles of 5 minutes of ischemia by inflating a cuff around a leg to 40 mm Hg above the systolic pressure . End points were development of acute kidney injury , initiation of dialysis , plasma creatinine , estimated glomerular filtration rate , plasma cystatin C , plasma and urinary neutrophil gelatinase-associated lipocalin , and urinary output . Secondary end points included postoperative blood pressure , inotropic score , and mortality , as well as morbidity reflected by reoperation and stays in the intensive care unit and hospital . RESULTS Overall , 57 of the children ( 54 % ) had acute kidney injury develop , with 27 ( 50 % ) in the remote ischemic preconditioning group and 30 ( 59 % ) in the control group ( P > .2 ) . Remote ischemic preconditioning was not associated with improvement in either any of the renal biomarkers or any of the secondary end points . CONCLUSIONS We found no evidence that remote ischemic preconditioning provided protection of kidney function in children undergoing operation for complex congenital heart disease BACKGROUND Reduced hemostatic capacity is common following  congenital heart surgery using cardiopulmonary bypass ( CPB ) . The etiology is multifactorial with dilutional coagulopathy , as well as platelet adhesion and activation in the CPB circuit and oxygenator . The purpose of the present study was to evaluate platelet count and function in children following CPB .  METHODS In a prospect i ve , observational study comprising 40 children , platelet count and function ( Multiplate Analyzer ( ® ) ) were measured before surgery , immediately after bypass , and on the first postoperative day . Furthermore , conventional coagulation analysis and thromboelastometry ( ROTEM ( ® ) ) were carried out . RESULTS A significant decrease in platelet count was observed immediately after coming of bypass ( P < 0.001 ) and persisted to the first postoperative day ( P = 0.002 ) . Platelet function was reduced immediately after bypass after induction with ADP ( P < 0.001 ) or TRAP ( P = 0.03 ) . The duration of CPB correlated significantly with the decrease in platelet count ( r = -0.62 , P = 0.0001 ) and reduction in platelet function ( r = -0.42 - 0.63 ; P < 0.01 ) . Moderate to deep hypothermia during CPB was associated with a decreased platelet function ( P = 0.01 - 0.12 ) , whereas cyanosis or previous heart surgery caused no further changes in platelet function following CPB . CONCLUSION Both platelet count and platelet function were significantly reduced after CPB in children undertaken correctional heart surgery . Duration of CPB and hypothermia was associated with significant changes in platelet function
Children and adolescents with CHD have lower VO2max and HR compared to controls
BACKGROUND Children and adolescents with congenital heart disease often have alterations in their exercise capacity that can be evaluated by various functional testing .
OBJECTIVE To evaluate the functional capacity of children and adolescents with congenital heart disease ( CHD ) with systematic review and meta-analyses .