Exercise studies in patients with transposition of the great arteries after atrial repair operations (Mustard/Senning): a review.

Exercise evaluation studies of patients after atrial repair surgery for transposition of the great arteries, as in tetralogy of Fallot, represent only a small fraction of the 3970 Medline references (1966 to mid-1997) concerning this congenital heart lesion. We have abstracted data from 27 studies from 20 institutions reporting on measurements during exercise on work capacity, heart rate response, respiratory gas exchange, or radionuclide/radiographic systemic ventricular ejection fraction measurements in addition to resting pulmonary function measurements. These studies provide almost uniform general conclusions that even after 20 or more years of follow-up (1) most patients "report" that they are asymptomatic in performing usual levels of physical activities; (2) significant abnormalities are present, often in more than half of the patients studied, in one or more of the exercise measurements when compared to control subjects; and (3) the diminished exercise performance is related to a diminished cardiac output, results from diminished stroke volume but is also related to a blunted heart rate response.