Asiyanotik Doğuştan Kalp Hastalıkları ve Spora Katılım
Özet
Konjenital kalp cerrahisinin gelişmesi, hastaların tanı almasında gecikmenin azalması, sağlık kuruluşuna ulaşmanın daha kolay olması gibi faktörlerden dolayı konjenital kalp hastalığı (KKH) olan hastaların sağkalımı artmıştır. Hastaların spora katılımla ilgili çok dikkatli değerlendirilmesi ve bu konuda teşvik edilmesinin sağkalım üzerinde nasıl etkilerinin olacağı, uzun dönem sonuçları, semptomların değerlendirilmesi çok yönlü yaklaşım gerektirir. Cerrahi veya transkateter müdahale sonrasında rehabilitasyon sürecinde sadece çocuk kardiyoloji branşı değil spor hekimi, fizyoterapist ve gerekli durumlarda elektrofizyolog yer almalıdır. Spora katılımı değerlendirirken spor sınıflamasını, kas çalışmasının bileşenlerini, egzersizin hacmi ve yoğunluğundaki farklılıkları hesaba katmak gerekir. Bazı sporlar yüksek motor aktivite ve beceri gerektirirken diğer sporlar düşük, orta, yüksek veya çok yüksek yoğunlukta gerçekleştirilir. Egzersiz programı veya spora katılım tavsiyesi verilirken spor türü, egzersiz programının sıklığı ve süresi, kişiye uygun yoğunluk tercihi belirtilmelidir. Asiyanotik konjenital kalp hastalıklarında basit şantlı defektler (ASD, VSD, PDA gibi) açık veya kapatıldıktan sonra hemodinamik açıdan önemli değilse ani kardiyak ölümle ilişkili olmadığından dolayı herhangi bir kısıtlama gerektirmez. Pulmoner hipertansiyon varlığında egzersiz kapasitesinde azalma, aritmi, senkop, göğüs ağrısı gibi semptomlar olabileceğinden spor sınırlandırılır. Obstrüktif KKH daha büyük çocuklarda ve erişkinlerde görülmesine karşın yenidoğan döneminde genellikle kritiktir ve girişim gerektirir. Pulmoner stenozlu (PS) hastaların egzersiz kapasitesinin sağlıklı bireylerin egzersiz kapasiteyle benzer olduğu ancak takipte akciğer fonksiyonu, aerobik metabolizma hızı ve egzersiz yükü kapasitesindeki azalmaya bağlı olarak aralıklı değerlendirilmesi gerektiği bildirilmiştir. Aort koarktasyonu hastalarında cerrahi onarım veya stent sonrasında bile kalan anormaliklerin devam etmesine bağlı o bölgede tekrar koarktasyon ya da anevrizma gelişebilir. Aortopati nedeniyle asendan aorta genişlemesi ve hatta yırtılma ihtimaline karşın yaşam boyu takip zorunludur. Düzenli müsabakalara katılan KKH'li sporcular altta yatan lezyona, hemodinamik ve elektrofizyolojik sekellere ve sporun özelliklerine bağlı olarak KKH ve spor kardiyolojisi alanında uzman kardiyologlar tarafından her 6-12 ayda bir yeniden değerlendirilmelidir. Bu hastaların rutin takibi dışında spora katılım ile ilgili daha fazla veri ve bilgiye ihtiyaç olduğu açıktır.
Referanslar
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Marelli AJ, Ionescu-Ittu R, Mackie AS, Guo L, Dendukuri N, Kaouache M. Lifetime prevalence of congenital heart disease in the general population from 2000 to 2010. Circulation 2014;130:749–756.
Diller GP, Kempny A, Alonso-Gonzalez R, Swan L, Uebing A, Li W, Babu- Narayan S, Wort SJ, Dimopoulos K, Gatzoulis MA. Survival prospects and circumstances of death in contemporary adult congenital heart disease patients under follow-up at a large tertiary centre. Circulation 2015;132: 2118–2125.
Downing, J. & Balady, G. J. The role of exercise training in heart failure. J. Am. Coll. Cardiol. 58, 561–569 (2011).
Ehlken, N. et al. Exercise training improves peak oxygen consumption and haemodynamics in patients with severe pulmonary arterial hypertension and inoperable chronic thrombo-embolic pulmonary hypertension: a prospective, randomized, controlled trial. Eur. Heart J. 37, 35–44 (2016).
Chastin, S. F. M. et al. How does light-intensity physical activity associate with adult cardiometabolic health and mortality? Systematic review with meta-analysis of experimental and observational studies. Br. J. Sports Med. 53, 370–376 (2019).
Pinto NM, Marino BS, Wernovsky G, de Ferranti SD, Walsh AZ, Laronde M, Hyland K, Dunn SO Jr, Cohen MS. Obesity is a common comorbidity in children with congenital and acquired heart disease. Pediatrics 2007;120:e1157–e1164.
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Referanslar
Dolk, H., Loane, M. A., Abramsky, L., de Walle, H., & Garne, E. (2010). Birth prevalence of congenital heart disease. Epidemiology (Cambridge, Mass.), 21(2), 275–277. https://doi.org/10.1097/EDE.0b013e3181c2979b
Longmuir, P. E., Tremblay, M. S., & Goode, R. C. (1990). Postoperative exercise training develops normal levels of physical activity in a group of children following cardiac surgery. Pediatric cardiology, 11(3), 126–130. https://doi.org/10.1007/BF02238841
Harmon, K. G., Drezner, J. A., Wilson, M. G., & Sharma, S. (2014). Incidence of sudden cardiac death in athletes: a state-of-the-art review. Heart (British Cardiac Society), 100(16), 1227–1234. https://doi.org/10.1136/heartjnl-2014-093872.rep
Maron, B. J., Zipes, D. P., Kovacs, R. J., & American Heart Association Electrocardiography and Arrhythmias Committee of Council on Clinical Cardiology, Council on Cardiovascular Disease in Young, Council on Cardiovascular and Stroke Nursing, Council on Functional Genomics and Translational Biology, and American College of Cardiology (2015). Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Preamble, Principles, and General Considerations: A Scientific Statement From the American Heart Association and American College of Cardiology. Circulation, 132(22), e256–e261. https://doi.org/10.1161/CIR.0000000000000236
Marelli AJ, Ionescu-Ittu R, Mackie AS, Guo L, Dendukuri N, Kaouache M. Lifetime prevalence of congenital heart disease in the general population from 2000 to 2010. Circulation 2014;130:749–756.
Diller GP, Kempny A, Alonso-Gonzalez R, Swan L, Uebing A, Li W, Babu- Narayan S, Wort SJ, Dimopoulos K, Gatzoulis MA. Survival prospects and circumstances of death in contemporary adult congenital heart disease patients under follow-up at a large tertiary centre. Circulation 2015;132: 2118–2125.
Downing, J. & Balady, G. J. The role of exercise training in heart failure. J. Am. Coll. Cardiol. 58, 561–569 (2011).
Ehlken, N. et al. Exercise training improves peak oxygen consumption and haemodynamics in patients with severe pulmonary arterial hypertension and inoperable chronic thrombo-embolic pulmonary hypertension: a prospective, randomized, controlled trial. Eur. Heart J. 37, 35–44 (2016).
Chastin, S. F. M. et al. How does light-intensity physical activity associate with adult cardiometabolic health and mortality? Systematic review with meta-analysis of experimental and observational studies. Br. J. Sports Med. 53, 370–376 (2019).
Pinto NM, Marino BS, Wernovsky G, de Ferranti SD, Walsh AZ, Laronde M, Hyland K, Dunn SO Jr, Cohen MS. Obesity is a common comorbidity in children with congenital and acquired heart disease. Pediatrics 2007;120:e1157–e1164.
McCrindle BW, Williams RV, Mital S, Clark BJ, Russell JL, Klein G, Eisenmann JC. Physical activity levels in children and adolescents are reduced after the Fontan procedure, independent of exercise capacity, and are associated with lower perceived general health. Arch Dis Child. 2007;92:509–514.
Massin MM, Hövels-Gürich HH, Gérard P, Seghaye MC. Physical activity patterns of children after neonatal arterial switch operation. Ann Thorac Surg. 2006;81:665–670.
Pemberton VL, McCrindle BW, Barkin S, Daniels SR, Barlow SE, Binns HJ, Cohen MS, Economos C, Faith MS, Gidding SS, Goldberg CS, Kavey RE, Longmuir P, Rocchini AP, Van Horn L, Kaltman JR. Report of the National Heart, Lung, and Blood Institute’s Working Group on obesity and other cardiovascular risk factors in congenital heart disease. Circulation. 2010;121:1153–1159.
Fredriksen PM, Kahrs N, Blaasvaer S, et al. Effect of physical training in children and adolescents with congenital heart disease. Cardiol Young 2000;10:107–14.
Rhodes J, Curran T, Camil L, et al. Impact of cardiac rehabilitation on the exercise function of children with serious congenital heart disease. Pediatrics 2005;116:1339–45.
Budts, W., Pieles, G. E., Roos-Hesselink, J. W., Sanz de la Garza, M., D'Ascenzi, F., Giannakoulas, G., Müller, J., Oberhoffer, R., Ehringer-Schetitska, D., Herceg-Cavrak, V., Gabriel, H., Corrado, D., van Buuren, F., Niebauer, J., Börjesson, M., Caselli, S., Fritsch, P., Pelliccia, A., Heidbuchel, H., Sharma, S., … Papadakis, M. (2020). Recommendations for participation in competitive sport in adolescent and adult athletes with Congenital Heart Disease (CHD): position statement of the Sports Cardiology & Exercise Section of the European Association of Preventive Cardiology (EAPC), the European Society of Cardiology (ESC) Working Group on Adult Congenital Heart Disease and the Sports Cardiology, Physical Activity and Prevention Working Group of the Association for European Paediatric and Congenital Cardiology (AEPC). European heart journal, 41(43), 4191–4199. https://doi.org/10.1093/eurheartj/ehaa501
Maron, B. J., Zipes, D. P., & Kovacs, R. J. (2015). Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Preamble, Principles, and General Considerations: A Scientific Statement From the American Heart Association and American College of Cardiology. Journal of the American College of Cardiology, 66(21), 2343–2349. https://doi.org/10.1016/j.jacc.2015.09.032
Van Hare GF, Ackerman MJ, Evangelista JA, Kovacs RJ, Myerburg RJ, Shafer KM, Warnes CA, Washington RL. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: Task Force 4: Congenital Heart Disease: a scientific statement from the American Heart Association and American College of Cardiology. J Am Coll Cardiol 2015;66:2372–2384.
Swan, L., & Hillis, W. S. (2000). Exercise prescription in adults with congenital heart disease: a long way to go. Heart (British Cardiac Society), 83(6), 685–687. https://doi.org/10.1136/heart.83.6.685
Dean, P. N., Gillespie, C. W., Greene, E. A., Pearson, G. D., Robb, A. S., Berul, C. I., & Kaltman, J. R. (2015). Sports participation and quality of life in adolescents and young adults with congenital heart disease. Congenital heart disease, 10(2), 169–179. https://doi.org/10.1111/chd.12221
Lunt, D., Briffa, T., Briffa, N. K., & Ramsay, J. (2003). Physical activity levels of adolescents with congenital heart disease. The Australian journal of physiotherapy, 49(1), 43–50. https://doi.org/10.1016/s0004-9514(14)60187-2
Casey, F. A., Craig, B. G., & Mulholland, H. C. (1994). Quality of life in surgically palliated complex congenital heart disease. Archives of disease in childhood, 70(5), 382–386. https://doi.org/10.1136/adc.70.5.382
Fredriksen, P. M., Kahrs, N., Blaasvaer, S., Sigurdsen, E., Gundersen, O., Roeksund, O., Norgaand, G., Vik, J. T., Soerbye, O., Ingjer, E., & Thaulow, E. (2000). Effect of physical training in children and adolescents with congenital heart disease. Cardiology in the young, 10(2), 107–114. https://doi.org/10.1017/s1047951100006557
Canadian Physical Activity Guidelines. Canadian Society for Exercise Physiology Web site. www.csep.ca. Accessed January 7, 2012.
Colley, R. C., Janssen, I., & Tremblay, M. S. (2012). Daily step target to measure adherence to physical activity guidelines in children. Medicine and science in sports and exercise, 44(5), 977–982. https://doi.org/10.1249/MSS.0b013e31823f23b1
Biddle, S. J., Atkin, A. J., Cavill, N., & Foster, C. (2011). Correlates of physical activity in youth: a review of quantitative systematic reviews. International review of sport and exercise psychology, 4(1), 25-49.
van der Horst, K., Oenema, A., Ferreira, I., Wendel-Vos, W., Giskes, K., van Lenthe, F., & Brug, J. (2007). A systematic review of environmental correlates of obesity-related dietary behaviors in youth. Health education research, 22(2), 203–226. https://doi.org/10.1093/her/cyl069
Budts, W., Börjesson, M., Chessa, M., van Buuren, F., Trigo Trindade, P., Corrado, D., Heidbuchel, H., Webb, G., Holm, J., & Papadakis, M. (2013). Physical activity in adolescents and adults with congenital heart defects: individualized exercise prescription. European heart journal, 34(47), 3669–3674. https://doi.org/10.1093/eurheartj/eht433
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