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(Circulation. 2002;106:2819.)
© 2002 American Heart Association, Inc.

Clinical Investigation and Reports

Abnormal Postexercise Cardiovascular Recovery and Its Determinants in Patients After Right Ventricular Outflow Tract Reconstruction

Hideo Ohuchi, MD; Hiroyuki Ohashi, MD; Jiksoo Park, MD; Johji Hayashi, MD; Aya Miyazaki, MD; Shigeyuki Echigo, MD

From the Department of Pediatrics, National Cardiovascular Center, Osaka, Japan.

Correspondence to Hideo Ohuchi, MD, Department of Pediatrics, National Cardiovascular Center, 5-7-1, Fujishiro-dai, Suita, Osaka 565-8565, Japan. E-mail hohuchi{at}hsp.ncvc.go.jp

Background— Abnormal responses of heart rate (HR) and oxygen uptake (O₂) during exercise characterize patients after right ventricular outflow tract reconstruction (RVOTR) for congenital heart defects. However, little is known about the postexercise dynamics.

Methods and Results— We evaluated postexercise cardiovascular dynamics in 52 patients after closure of an atrioventricular septal defect (group A), 79 patients after RVOTR (group B), and 44 control subjects. HR variability, arterial baroreflex sensitivity (BRS), plasma norepinephrine, and hemodynamics were measured. Although there was no difference between group A and control subjects, declines in HR and O₂ after light and peak exercise and in systolic blood pressure (SBP) after peak exercise were delayed in group B. Age, low-frequency component of HR variability, and plasma norepinephrine were independent determinants of early HR decline. Peak SBP and O₂ had a great impact on the corresponding recoveries. When the peak values were excluded, body weight, BRS, and right ventricular ejection fraction were independent determinants of early SBP decline. BRS and the pulmonary artery resistance were independent determinants of O₂ decline throughout recovery, and age and right systolic ventricular pressure also determined the early O₂ decline. BRS and low-frequency component of HR variability were determined independently by the number of surgical procedures.

Conclusions— In RVOTR patients, in addition to metabolic and autonomic maturation, surgery-related abnormal cardiac autonomic nervous activity and impaired hemodynamics have a great impact on delayed postexercise cardiovascular recovery.

Key Words: heart defects, congenital • nervous system, autonomic • exercise • blood pressure

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