Cardiopulmonary function in children with congenital heart disease aged 8-12 years: eoes performance meet perception?

Abstract

Introduction: Little is known about the functional implications in children with repaired congenital heart disease in terms of the stresses of exercise and hypoxia, lung function, quality of life and body composition. Methods: Children with repaired Atrial Septal Defects (ASD), Ventricular Septal Defects (VSD) and Tetralogy of Fallot (TOF) aged 8-12 years were recruited along with healthy controls. Participants completed a maximal exercise (VO2max) test, six minute walk test (6MWT), spirometry, anthropometry, the Habitual Activity Estimation Scale (HAES), the Paediatric Quality of Life Inventory (PedsQL) and a hypoxia challenge test. Results: Of 396 children invited to participate 29 accepted (7.3%) along with an age matched control giving groups of ASD (12), VSD (9), TOF (8) and 29 controls. Compared with controls the TOF group had a significantly reduced VO2max (38.6 ± 7.5 ml/kg/min : 47.5 ± 11.4 ml/kg/min) as well as a significantly impaired self-reported QOL (64.5 ± 10.6 : 47.5 ± 11.4 ml/kg/min) and parent reported QOL (68.6 ± 18.9 : 87.8 ± 7.6). Parents of the ASD and VSD groups also reported their children as having an impaired QOL (ASD: 67.8 ± 24.7; VSD: 71.3 ± 17.4; Control 87.8 ± .6). There was no significant difference in the 6 minute walk test, lung function, BMI, body fat, self-reported habitual activity (HAES) and SaO2 at sea level. The hypoxia challenge test showed a non-significant pattern of decreasing SaO2 with TOF subjects having the lowest SaO2 at an FiO2 of 15% (CON: 90 ± 1.7%; ASD: 88.7 ± 1.2%, VSD: 88.6 ± 2.1%; TOF: 84.5 ± 4.9%). Conclusions: Children with repaired TOF have a significantly lower VO2max and self-reported QOL compared with those with a repaired ASD or VSD and controls. Those with TOF are at a greater risk of hypoxia during airline travel. Children with a repaired TOF may benefit from a structured exercise program aimed at improving exercise capacity, quality of life and oxygen profile in an hypoxic environment.