EXERCISE CAPACITY IN YOUNG PATIENTS AFTER CORRECTION OF TETRALOGY OF FALLOT AND AFTER ATRIAL SWITCH (SENNING OPERATION) OF TRANSPOSITION OF GREAT ARTERIES IN LONG TERM FOLLOW UP
We observed 52 patients who were divided into two groups: Group I - 37 patients after correction of tetralogy of FallotTOF (7 females and 30 males) at the age from 8,7 to 21,7 yrs (mean age 14,6 yrs). Group II consisted of 15 patients after operation of transposition of great arteries ( TGA) by Senning method ( 6 girls and 9 boys) at the age from 7,3 to 17,8 yrs (mean age 13,1 yrs).
In all patients 24-hour Holter ECG monitoring was performed with assessment of heart rhythm, presence of arrhythmias. Also treadmill exercise testing (TT) was done in all patients and modified Bruce protocol was used. We estimated total metabolic equivalent (MET), total exercise time , presence of arrhythmias and changes in ST segment. In 10pts (27,03%)from the group I ventricular arrhythmias were noticed, but only in 3 subjects complex arrhythmia was present. In patients from group II dysfunction of sinus node was observed -5 pts (35,7%).
Significant changes of ST segment and dysfunction of right ventricle during TT was present in 5 patients after TOF (13,6%) whereas such changes with additional chest pain could be seen in 6 patients (40%) after Senning operation. During TT mean MET parameters achieved by pts after TOF were significantly higher than in patients after Senning operation (14,12 v 12,76) as well as TT time duration was significantly longer in pts after TOF operation (13:12 v 10:39).
In 3 pts (8,1%) after TOF reoperation and/or ICD implantation was considered, while also 3 pts (20%) needed reintervention.
Conclusions: Patients after correction of tetralogy of Fallot have much more better long term prognosis in comparison to patients after Senninng operation of transposition of great arteries. Systemic right ventricle dysfunction is frequently observed in patients after Senninng operation of transposition of great arteries. Exercise treadmill test could be very useful in determination of high risk patients after complex congenital heart defects correction.