Exercise Testing After Pediatric Heart Transplantation
Heart transplantation is an established therapy in children with end-stage heart failure. Ninety percent of pediatric heart transplant recipients have congenital heart disease or cardiomyopathy as the underlying disease. Exercise performance in the early posttransplant period is affected by factors that precede transplant, such as malnutrition and deconditioning from heart failure, as well as associated medical conditions (e.g., neuromuscular disease). Improvement in exercise performance in the months following transplant may be aided by referral to a formal rehabilitation program. Performance on long-term follow-up remains subnormal due to transplant-specific factors such as cardiac autonomic denervation with resulting chronotropic incompetence and persistent left ventricular diastolic dysfunction. Exercise testing with stress echocardiography has potential utility in noninvasive surveillance for posttransplant coronary artery disease.
KeywordsHeart transplant Exercise test Cardiac autonomic denervation Reinnervation
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