The effect of exercise training in symptomatic patients with grown-up congenital heart disease: a review

Introduction: The number of grown-up congenital heart disease (GUCH) patients is steadily increasing. Unfortunately, the majority of these patients suffer from late sequelae, with heart failure being the most common cause of death. Exercise training is beneficial and safe in patients with acquired heart failure, as well as in asymptomatic GUCH patients. However, its effect remains unknown in symptomatic GUCH patients. This could cause reticence on positive sports advice, with possible counterproductive effects.

Areas covered: A review of current literature was performed to evaluate the effect of exercise training in symptomatic (NYHA≥2) GUCH patients. The search yielded a mere three studies including symptomatic patients, and another six studies including also patients in NYHA 1 without making clear distinction between the NYHA subgroups.

Expert commentary: Suboptimal trial designs, low patient numbers, and homogeneity of investigated cardiac anomalies make this review insufficient to draw definite conclusions. However, all studies describe overall positive effects of exercise training in symptomatic GUCH patients in terms of exercise capacity and quality of life. There were no safety concerns. Larger-scaled, randomized controlled trials are needed to obtain certainty.     

Perception of general health in adults with congenital heart disease who no longer attend medical follow-up

Background

Numerous patients with congenital heart disease (CHD) do not attend regular follow-up. How these patients perceive their health is unknown. A news story recently reached the front pages in Denmark, stating that patients with CHD not attending medical follow-up could be at great risk. This made a number of “lost” patients come forward and offered a unique opportunity to learn more about how these patients manage life.

Aims

To describe the perception of general health in a sample of grown-up congenital heart disease (GUCH) patients who are no longer in medical follow-up and to determine whether patients feel affected in daily life because of their heart disease.

Methods

A convenient sample of 125 respondents was asked to complete a questionnaire, using questions from Short Form 36 and self-constructed questions. Data were processed in SPSS and analysed by means of Student's t-test, ANOVA, Chi-square test, and Pearson's correlation coefficient.

Results

125 patients participated, with a mean age of 38 years, 37% were men. Mean scores for general health perception were 75.8 for men and 77.2 for women. The scores seem to follow the pattern seen in the general population. Most patients, 83%, did not feel limited in their daily activities. 67% of women and 52% of men, however, worried about their heart disease.

Conclusion

Patients not attending medical follow-up seem to be affected to some degree by their heart disease.     

Caesarean delivery in a parturient with a femoro-femoral crossover graft and congenital aortic stenosis repaired by the Ross procedure

We report a case of a patient with congenital aortic stenosis previously repaired using the Ross procedure, who presented to our unit for urgent caesarean delivery. Management was complicated by moderate residual cardiac disease and the presence of a suprapubic femoro-femoral crossover graft. Following application of five-lead electrocardiogram and invasive blood pressure monitoring, anaesthesia was induced via combined spinal-epidural with epidural volume extension. A high transverse surgical approach avoided the course of the vascular graft, while further precautions included the immediate availability of vascular surgeons and cell salvage. Our anaesthetic technique was tailored to minimise disruption to cardiovascular function, and in particular to limit regurgitant flow across the pulmonary valve. This case highlights the value of early identification of high-risk parturients and multidisciplinary involvement at delivery. Risk stratification in the patient with grown-up congenital heart disease is based upon timely evaluation of the underlying congenital pathology, surgical history and subsequent functional status.