CARDIOPULMONARY PERFORMANCE AT REST AND EXERCISE AFTER REPAIR OF TOTAL ANOMALOUS PULMONARY VENOUS CONNECTION

Although long-term evaluations of patients after repair of total anoma lous pulmonary venous connection have generally shown them to be clini cally asymptomatic, assessment of their cardiovascular and pulmonary s ystems have been limited. Residual cardiopulmonary abnormalities undet ected at rest may result in impaired function during exercise. To eval uate this hypothesis 9 patients underwent exercise testing after repai r of total anomalous pulmonary venous connection. Pulmonary function t esting was performed before exercise. Patients exercised using a 1-min ute incremental bicycle or treadmill protocol monitoring heart rate, o xygen consumption, carbon dioxide production and minute ventilation. C ompared with healthy children, the study patients had reduced maximal oxygen consumption and reduced oxygen consumption at ventilatory anaer obic threshold. Chronotropic response was impaired in 5 patients. Rest ing pulmonary functions showed evidence of mild restrictive lung disea se. Breathing reserve was within normal limits. It is concluded that ( 1) aerobic capacity is mildly reduced after repair of total anomalous pulmonary venous connection, (2) chronotropic impairment is a common o ccurrence, and (3) pulmonary testing suggests mild restrictive lung di sease that does not compromise exercise performance.