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Right arrow Congenital - acyanotic

J Thorac Cardiovasc Surg 2009;137:380-384
© 2009 The American Association for Thoracic Surgery

Congenital Heart Disease

Exercise performance and quality of life following surgical repair of anomalous aortic origin of a coronary artery in the pediatric population

J.A. Brothers, MDa,*, M.G. McBride, PhDa, B.S. Marino, MD, MPP, MSCEb, R.S. Tomlinson, BSEb, M.A. Seliem, MDa, M.H. Pampaloni, MD, PhDc, J.W. Gaynor, MDd, T.L. Spray, MDd, S.M. Paridon, MDa

a Division of Cardiology, The Children's Hospital of Philadelphia and the University of Pennsylvania, Philadelphia, Penn
b Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia and the University of Pennsylvania, Philadelphia, Penn
c Department of Radiology, The Children's Hospital of Philadelphia and the University of Pennsylvania, Philadelphia, Penn
d Division of Cardiothoracic Surgery, The Children's Hospital of Philadelphia and the University of Pennsylvania, Philadelphia, Penn

Received for publication April 28, 2008; revisions received July 8, 2008; accepted for publication August 4, 2008.

* Address for reprints: Julie A. Brothers, MD, The Children's Hospital of Philadelphia, 34th and Civic Center Blvd, Division of Cardiology, Main Building, 8NW Room 72, Philadelphia, PA 19104. (Email: brothersj{at}email.chop.edu).

Objective: We sought to evaluate exercise performance and quality of life in children after surgical repair of anomalous aortic origin of a coronary artery with an interarterial course.

Methods: Patients who had surgery from October 2001 to January 2007 were eligible for inclusion. Exercise performance and quality of life were prospectively assessed by maximal exercise tests and age-appropriate questionnaires, respectively. We used t tests to compare pre- and postoperative exercise data and quality-of-life scores to published normative data. We performed linear regression analyses to assess associations between demographic, anatomic, and exercise variables and quality-of-life score.

Results: Of 25/27 patients, 64% were boys, 68% had anomalous right coronary, 32% were asymptomatic. Average age at surgery was 10.8 (±4.1) years; median follow-up was 14.5 (2 to 48) months. Postoperative percent-predicted exercise values were: peak heart rate 97 (±6), working capacity 91 (±15), maximal oxygen consumption 82 (±16). In those who had preoperative exercise testing (n = 11), resting and maximal heart rates decreased significantly without significant change in exercise performance. Average child quality of life was 85/100 (±13) and parent-proxy 88 (±11) compared with normal scores of 83 (±15) and 88 (±12), respectively.

Conclusion: There is mild chronotropic impairment in children and adolescents following anomalous coronary artery repair without a decline in exercise performance. This does not appear to impair their overall quality of life. Because long-term effects on heart rate, exercise performance, and quality of life are unknown, serial exercise tests should be included as routine care of these patients.

Abbreviations and Acronyms AAOCA = anomalous aortic origin of a coronary artery that courses between the 2 great arteries; ALCA = left main coronary artery arises from the right sinus of Valsalva; ARCA = right coronary arises from the left sinus of Valsalva; EST = exercise stress test; PHR = peak heart rate; PWC = physical working capacity; QOL = quality of life; RER = respiratory exchange ratio; VO2max = maximal oxygen consumption or aerobic capacity






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