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(Chest. 2005;128:1010-1017.)
© 2005 American College of Chest Physicians

Does Delayed Correction Interfere With Pulmonary Functions and Exercise Tolerance in Patients With Tetralogy of Fallot?*

Murat Ercisli, MD; Kerem M. Vural, MD; Kutay N. Gokkaya, MD; Fusun Koseoglu, MD; Omac Tufekcioglu, MD; Erol Sener, MD and Oguz Tasdemir, MD

* From the Departments of Cardiovascular Surgery (Drs. Ercisli, Vural, Sener, and Tasdemir) and Cardiology (Dr. Tufeckioglu), Yuksek Ihtisas Hospital of Turkey, Ankara, Turkey; and the Ankara Physical Medicine and Rehabilitation Education and Research Hospital (Drs. Gokkaya and Koseoglu), Ankara, Turkey.

Correspondence to: Kerem M. Vural, MD, N. Tandogan cad. 5/6 Kavaklidere, 06540 Ankara, Turkey; e-mail: kvural{at}tr.net

Study objectives: To assess exercise tolerance and determine the distinct role of cardiac, respiratory, or peripheral factors on it after delayed surgical repair in patients with tetralogy of Fallot.

Design: The aerobic exercise capacity of 15 adult patients (mean [± SD] age, 21 ± 6; age range, 9 to 30 years) undergoing successful total correction at a mean age of 12 ± 5 years (patients) was compared to healthy, matched control subjects by using right ventricle echocardiography, resting spirometry, and cardiopulmonary exercise tests at a mean postoperative time of 7.5 ± 4.6 years.

Setting: Tertiary care referral centers.

Patients: Fifteen adult patients (mean age, 21 ± 6 years; age range, 9 to 30 years) undergoing successful total correction at a mean age of 12 ± 5 (patients) and 15 healthy, matched volunteers (control subjects).

Results: There was evidence for a slight right ventricular diastolic dysfunction in the patients. Mean FVC (88 ± 9% vs 109 ± 12% predicted, respectively) and FEV1 (89 ± 9% vs 109 ± 12% predicted, respectively), although being within the normal range, were also decreased in comparison to those of control subjects (p < 0.0001). Maximal oxygen consumption (O2max) decreased in both groups (55 ± 16% vs 61 ± 23% predicted, respectively; p = 0.5); however, there were more individuals with severely decreased values among the patients (p = 0.05). O2 at the anaerobic threshold was also decreased in patients (33 ± 15% vs 51 ± 8% predicted, respectively; p = 0.004). The maximum tolerable exercise time was 17.3 ± 4.5 min in patients vs 21.2 ± 6.4 min in control subjects (p = 0.06).

Conclusions: The exercise capacity after delayed repair was good in general compared to matched control subjects; however, exercise capacity may be slightly limited by ventilatory dysfunction, low anaerobic threshold, and lack of physical fitness despite New York Heart Association class improvement after undergoing the operation.

Key Words: exercise test • exercise tolerance • metabolism • quality of life • respiratory function tests • tetralogy of Fallot






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