Kindergarten Children with Congenital Heart Disease Show Good Physical Activity but Reduced Motor Skills in Comparison with Healthy Children.

Objective: For the interaction of individuals with their environment, motor competence is of major importance. It is known that school children with congenital heart disease (CHD) have motoric limitations even without hemodynamic residuals. Data from kindergarten children is lacking. This study was to compare the motor competence of kindergarten children with congenital heart disease (4-6 years) with healthy children of the same age group. Patients and Methods: A motor test “MOT 4-6” with 18 tasks in different groups of motor skills was performed in 62 children (19 female, 43 male) with various forms of CHD and compared to 39 healthy children (22 female, 17 male). In addition to the motor test all subjects answered the Kiddy- KINDL® quality of life questionnaire, and wore an accelerometer to capture daily physical activity for seven consecutive days. Results: The median (quartile 1; quartile 3) motor quotient in the CHD group (104 [96;113]) was significantly lower than in the control group (111 [104;116]; Mann-Whitney-U test p=0.005). Quality of life did not differ significantly (p=0.774, parents’ questionnaire p=0.066), nor the minutes in moderate and vigorous physical activity (p=0.093). No correlation between the motor quotient and the other variables could be shown. Conclusion: Kindergarten children with CHD should be screened for a normal motor development. This delay seems to be independent from daily physical activity.

Athlete’s Heart with a Systemic Right Ventricle.

Objective: High load of regularly vigorous exercise leads to multiple physiological adaptations. The major cardiovascular effects are hypertrophy and dilation, predominantly of the left ventricle, and bradycardia. However, there are no reports on an athlete’s heart in a systemic right ventricle. Subject: We report on a 23 year old male endurance athlete (177cm, 69kg) with a systemic subaortic right ventricle after atrial redirection (Senning procedure) for simple transposition of the great arteries in infancy. Albeit medical doctors had imposed activity restriction to him, he has lead an active lifestyle from early childhood on, intensifying his sport activities over the years especially in cycling and running to a training volume of about 10 hours per week in winter and about 15 hours per week in summer. In 2009 he performed 1:50h on the half marathon distance. In 2013 he finished his first Marathon in 4:34h. Results: Cardiopulmonary exercise testing revealed a maximum oxygen uptake of 52.3ml/min/kg and a peak work load of 353 Watt, corresponding to 5.1Watt per kilogram body mass. Cardiovascular Magnetic Resonance showed a cardiac index of 2.9ml/min/m², a tricuspid regurgitation fraction of 4%, and a systemic right ventricle enddiastolic volume of 109ml/m² with an ejection fraction of 53%. Conclusions: With regular exercise training a systemic right ventricle can become very efficient comparable to healthy amateur athletes.

No Synergic Effect of Sildenafil Administration on Exercise Capacity Improvement in a Fontan Patient with Regular Exercise Training.

In Fontan patients, reduced exercise capacity due to diminished cardiac output is a common finding with important prognostic implications. Beneficial effects have been shown for sildenafil treatment and regular exercise, but data comparing both strategies is scarce. We report on a female patient with Fontan circulation who underwent repeated cardiopulmonary exercise tests with either placebo or a single dose of 50mg sildenafil before and after 6months of supervised aerobic and resistance exercise. At baseline, V O2peak was 29.1ml/min/kg, and a marked increase to 32.8ml/min/kg was observed after administration of sildenafil. After the training period, V O2peak was 34.5ml/kg/min in the placebo test, and no further increase by sildenafil was possible (33.7ml/kg/min). Similar results were observed for exercise capacity at the ventilatory anaerobic threshold. In summary, this Fontan patient showed that regular exercise might use up and probably exceed the acute sildenafil effects on exercise capacity. Exercise should be considered as a primary treatment strategy within secondary prevention and rehabilitation after the Fontan procedure.