Abstract
BackgroundPatients with Senning repair for complete transposition of the great arteries (d-TGA) show an impaired exercise tolerance. Our aim was to investigate changes in exercise capacity in children, adolescents and adults with Senning operation.MethodsPeak oxygen uptake (peak VO2), oxygen pulse and heart rate were assessed by cardiopulmonary exercise tests (CPET) and compared to normal values. Rates of change were calculated by linear regression analysis. Right ventricular (RV) function was assessed by echocardiography.ResultsThirty-four patients (22 male) performed 3.5 (range 3–6) CPET with an interval of ≥ 6 months. Mean age at first assessment was 16.4 ± 4.27 years. Follow-up period averaged 6.8 ± 2 years. Exercise capacity was reduced (p<0.0005) and the decline of peak VO2 (−1.3 ± 3.7 %/year; p=0.015) and peak oxygen pulse (−1.4 ± 3.0 %/year; p=0.011) was larger than normal, especially before adulthood and in female patients (p<0.01). During adulthood, RV contractility changes were significantly correlated with the decline of peak oxygen pulse (r= −0.504; p=0.047).ConclusionsIn patients with Senning operation for d-TGA, peak VO2 and peak oxygen pulse decrease faster with age compared to healthy controls. This decline is most obvious during childhood and adolescence, and suggests the inability to increase stroke volume to the same extent as healthy peers during growth. Peak VO2 and peak oxygen pulse remain relatively stable during early adulthood. However, when RV contractility decreases, a faster decline in peak oxygen pulse is observed.
Highlights
Patients with Senning repair for complete transposition of the great arteries (d-TGA) show an impaired exercise tolerance
* Correspondence: roselien.buys@faber.kuleuven.be 1Department of Rehabilitation Sciences, Research Center for Cardiovascular and Respiratory Rehabilitation, KULeuven, Tervuursevest 101, Leuven 3001, Belgium Full list of author information is available at the end of the article substantially reduced exercise capacity, which probably lowers faster with age compared to healthy controls [2,3,4,5,6,7,8]
This study shows at first that patients with Senning operation for Complete transposition of the great arteries (d-TGA) have a lower exercise capacity, as expressed by peak Peak oxygen uptake (VO2), peak oxygen pulse and peak heart rate, than what would be expected in a healthy population
Summary
Patients with Senning repair for complete transposition of the great arteries (d-TGA) show an impaired exercise tolerance. Until about 1980, most children with complete transposition of the great arteries (d-TGA) underwent the Mustard or the Senning operation. These atrial switch techniques were replaced when an arterial switch procedure was introduced which allows for a systemic left ventricular function. Reybrouck et al performed a longitudinal study in children and adolescents with atrial switch operation [3] They concluded that in the overall group, the exercise performance remained stable during a follow-up of 3.5 ± 2 years, but that in individual patients, a decreasing exercise capacity was correlated with the development of hemodynamic lesions [3]
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