Children with an isolated VSD are generally as healthy and physically fit as other children and should not be discouraged from engaging in strenuous exercise, a research team has found.

Children with an isolated ventricular septal defect are generally as healthy and physically fit as other children and should not be discouraged from engaging in strenuous exercise, a Dutch research team has found.

"Our study contradicts various previous reports in that it describes that true overprotection hardly ever occurs in children with this specific subtype of congenital heart disease," lead investigator Dr. Mathijs Binkhorst told Reuters Health.

To determine appropriate exercise levels, the researcher explained, "We combined exercise testing, activity monitoring and a questionnaire to see whether or not children with a patent or closed ventricular septal defect (VSD) fall short in their cardiopulmonary capacity compared to their healthy peers, and also whether or not these VSD children partake in the same activities as their cardiopulmonarily sound counterparts."

As reported in the October 15th issue of the American Journal of Cardiology, Dr. Binkhorst and colleagues at Radboud University Nijmegen Medical Centre studied 27 children with isolated VSDs and 15 healthy controls, ages eight to 17 years. Thirteen subjects had a hemodynamically relevant defect that had been surgically closed, while in the other 14 affected subjects, the defect was smaller and was still present or had spontaneously closed.

The subgroup of children who had undergone surgery had significantly lower peak heart rates and somewhat lower energy expenditures. Nevertheless, after adjusting for weight and body fat, the investigators found that peak oxygen uptake, peak workload, and energy expenditure did not differ significantly between children with and without a history of VSD.

"Contrary to one's common sense and intuition, children with a moderately severe congenital heart defect - some of whom even had open-heart surgery - are capable of exercising with the same intensity and endurance as children with an uneventful medical history," Dr. Binkhorst noted.

"Clinicians are also able to inform parents of patients who are about to face the ordeal of VSD treatment/operation that the prospect for the future is not that cumbersome at all," he added.

Nevertheless, he advises physicians to tailor their recommendations according to patient history, defect size, complications, operational details, and other relevant clinical factors.

As for the chronotropic limitation seen in VSD children in whom cardiac surgery had been performed, "this was not at all anticipated, but emerged as a surprising, though unambiguous result," Dr. Binkhorst said. Because cannulation and cardiopulmonary bypass may be responsible for these aberrations, "a possibly important implication of our study is that the procedure of cardiopulmonary bypass has to be revised."

Am J Cardiol 2008;102:1079-1084