Exercise and sports in congenital heart disease

The vast majority of haemodynamically important congenital heart malformations are nowadays amenable to surgery. Patients with large left-to-right shunts through a ventricular septal defect, patent ductus arteriosus or atrioventricular canal will undergo a corrective operation in the first years of life in order to prevent the development of obstructive pulmonary vascular disease. Because detection is usually later in life and pulmonary hypertension is rather exceptional, atrial septal defect is often corrected at school-going age. Severe pulmonic stenosis and coarctation of the aorta can be successfully relieved at any age, even, if necessary, in early infancy. The two most common cyanotic cardiac malformations need early palliation or correction. In most centres uncomplicated transposition of the great arteries will be functionally corrected by a venous switch operation in the first months of life. Our management of tetralogy of Fallot has dramatically changed during the last decade: few palliative procedures are being performed and they are limited to very young patients in whom the main pulmonary artery is judged to be too small for a safe correction. Although elective surgery may be postponed until late pre-school age (4 to 5 years), the results nowadays are equally satisfying if complete repair is undertaken at a younger age. Most of these operated patients lead normal lifes as adolescents and adults and are able to participate with their peers in sports and physical activities. In some patients, however, the result is not optimal because of residual lesions, impaired myocardial function or surgical trauma to the conduction tissue [8]. Guidelines for operated patients will be discussed in the next paper.