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Exercise capacity after repair of tetralogy of fallot in infancy

      The long-term outcome of children after complete repair of tetralogy of Fallot (ToF) has been well described.
      • Murphy J.G.
      • Gersh B.J.
      • Mair D.D.
      Long-term outcome in patients undergoing surgical repair of tetralogy of Fallot.
      ,
      • Fuster V.
      • McGoon D.C.
      • Kennedy M.A.
      • Ritter D.G.
      • Kirklin J.W.
      Long-term evaluation (12 to 22 years) of open heart surgery for tetralogy of Fallot.
      Impairment in exercise tolerance has been frequently reported
      • Carvalho J.S.
      • Shinebourne E.A.
      • Busst C.
      • Rigby M.L.
      • Redington A.N.
      Exercise capacity after complete repair of tetralogy of Fallot deleterious effects of residual pulmonary regurgitation.
      ,
      • Wessel H.U.
      • Cunningham W.J.
      • Pault M.H.
      Exercise performance in tetralogy of Fallot after intracardiac repair.
      ,
      • Rowe S.A.
      • Zahka K.G.
      • Manolio T.A.
      • Horneffer P.J.
      • Kidd L.
      Lung function and pulmonary regurgitation limit exercise capacity in postoperative tetralogy of Fallot.
      ,
      • Rhodes J.
      • Dave A.
      • Pulling M.C.
      Effect of pulmonary artery stenoses on the cardiopulmonary response to exercise following repair of tetralogy of Fallot.
      and speculated to be due to a number of causes including residual right ventricular (RV) outflow tract obstruction,
      • Bove E.L.
      • Kavey R.E.W.
      • Byrum C.J.
      • Sondheimer H.M.
      • Blackman M.S.
      • Thomas F.D.
      Improved right ventricular function following late pulmonary valve replacement for residual pulmonary insufficiency or stenosis.
      branch pulmonary artery stenoses,
      • Rhodes J.
      • Dave A.
      • Pulling M.C.
      Effect of pulmonary artery stenoses on the cardiopulmonary response to exercise following repair of tetralogy of Fallot.
      pulmonary insufficiency,
      • Carvalho J.S.
      • Shinebourne E.A.
      • Busst C.
      • Rigby M.L.
      • Redington A.N.
      Exercise capacity after complete repair of tetralogy of Fallot deleterious effects of residual pulmonary regurgitation.
      ,
      • Rowe S.A.
      • Zahka K.G.
      • Manolio T.A.
      • Horneffer P.J.
      • Kidd L.
      Lung function and pulmonary regurgitation limit exercise capacity in postoperative tetralogy of Fallot.
      ,
      • Bove E.L.
      • Kavey R.E.W.
      • Byrum C.J.
      • Sondheimer H.M.
      • Blackman M.S.
      • Thomas F.D.
      Improved right ventricular function following late pulmonary valve replacement for residual pulmonary insufficiency or stenosis.
      ,
      • Mulla N.
      • Simpson P.
      • Sullivan N.M.
      • Paridon S.M.
      Determinants of aerobic capacity during exercise following complete repair of tetralogy of Fallot with a transannular patch.
      ,
      • Niezen R.A.
      • Helbing W.A.
      • van der Wall E.E.
      • van der Geest R.J.
      • Rebergen S.A.
      • de Roos A.
      Biventricular systolic function and mass studied with MR imaging in children with pulmonary regurgitation after repair for tetralogy of Fallot.
      chronotropic incompetence,
      • Wessel H.U.
      • Cunningham W.J.
      • Pault M.H.
      Exercise performance in tetralogy of Fallot after intracardiac repair.
      and pulmonary pathology.
      • Leyh R.
      • Bohle A.
      • Sievers H.H.
      • Bernhard A.
      Does an aortopulmonary shunt before repair of tetralogy of Fallot limit exercise tolerance in long-term survivors?.
      ,
      • Jonsson H.
      • Ivert T.
      • Jonasson R.
      Pulmonary function thirteen to twenty-six years after repair of tetralogy of Fallot.
      ,
      • Tomassoni T.L.
      • Galioto F.M.
      • Vaccaro P.
      Cardiopulmonary exercise testing in children following surgery for tetralogy of Fallot.
      Published reports have focused on children with an older age at repair.
      • Murphy J.G.
      • Gersh B.J.
      • Mair D.D.
      Long-term outcome in patients undergoing surgical repair of tetralogy of Fallot.
      ,
      • Fuster V.
      • McGoon D.C.
      • Kennedy M.A.
      • Ritter D.G.
      • Kirklin J.W.
      Long-term evaluation (12 to 22 years) of open heart surgery for tetralogy of Fallot.
      ,
      • Carvalho J.S.
      • Shinebourne E.A.
      • Busst C.
      • Rigby M.L.
      • Redington A.N.
      Exercise capacity after complete repair of tetralogy of Fallot deleterious effects of residual pulmonary regurgitation.
      ,
      • Wessel H.U.
      • Cunningham W.J.
      • Pault M.H.
      Exercise performance in tetralogy of Fallot after intracardiac repair.
      ,
      • Rowe S.A.
      • Zahka K.G.
      • Manolio T.A.
      • Horneffer P.J.
      • Kidd L.
      Lung function and pulmonary regurgitation limit exercise capacity in postoperative tetralogy of Fallot.
      ,
      • Bove E.L.
      • Kavey R.E.W.
      • Byrum C.J.
      • Sondheimer H.M.
      • Blackman M.S.
      • Thomas F.D.
      Improved right ventricular function following late pulmonary valve replacement for residual pulmonary insufficiency or stenosis.
      ,
      • Leyh R.
      • Bohle A.
      • Sievers H.H.
      • Bernhard A.
      Does an aortopulmonary shunt before repair of tetralogy of Fallot limit exercise tolerance in long-term survivors?.
      ,
      • Jonsson H.
      • Ivert T.
      • Jonasson R.
      Pulmonary function thirteen to twenty-six years after repair of tetralogy of Fallot.
      ,
      • Tomassoni T.L.
      • Galioto F.M.
      • Vaccaro P.
      Cardiopulmonary exercise testing in children following surgery for tetralogy of Fallot.
      ,
      • Sarubbi B.
      • Pacileo G.
      • Pisacane C.
      • Ducceschi V.
      • Iacono C.
      • Russo M.G.
      • Iacono A.
      • Calbro R.
      Exercise capacity in young patients after total repair of tetralogy of Fallot.
      ,
      • Takahashi O.
      • Futaki S.
      • Kamiya T.
      Exercise capacity of patients with post-operative tetralogy of Fallot.
      Repair in infancy frequently necessitates placement of a transannular patch, and raises concerns as to the long-term effect of chronic pulmonary insufficiency in those repaired at an early age. Although there is a growing body of published data on those repaired in early childhood,
      • Rhodes J.
      • Dave A.
      • Pulling M.C.
      Effect of pulmonary artery stenoses on the cardiopulmonary response to exercise following repair of tetralogy of Fallot.
      ,
      • Mulla N.
      • Simpson P.
      • Sullivan N.M.
      • Paridon S.M.
      Determinants of aerobic capacity during exercise following complete repair of tetralogy of Fallot with a transannular patch.
      the long-term impact on aerobic capacity in those repaired during infancy remains unknown. We sought to assess long-term outcome of children with ToF repaired in infancy (age <18 months), with an emphasis on cardiopulmonary exercise performance, and to identify any potential factors associated with impaired aerobic capacity. In addition, we sought to compare exercise performance in children repaired in infancy with that in similar children who were repaired at an older age.
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