Abstract
Objective. To develop an optimal rehabilitation program directed at increasing physical performance, improving the ventilation capacity of the lungs, increasing immunity and prevention liver damage in children the long-term period after a Fontan procedure.
Material and methods. At the Rehabilitation Center for Children with Heart Diseases, 36 children were examined in the long-term period after a Fontan procedure in the modification of an extracardiac conduit at the age from 5 to 16 years. At the beginning of the rehabilitation course, all children underwent a study of a clinical status, echocardiography, ECG, 24-hour ECG monitoring using the Holter method, 24-hour blood pressure monitoring, clinical blood and urine tests, biochemical blood test with determination of the level of liver enzymes, computer spirometry, cardiopulmonary exercise testing , bicycle ergometry , 6-minute walk test. After the examination, the children were prescribed a complex of medical rehabilitation, that included physiotherapy exercises (in the gym, or aqua gymnastics) mainly for the muscles of the upper and lower extremities, massage of the lower extremities, halotherapy, transcranial electrical stimulation, enteral oxygen therapy. Physical training was selected individually for each child, depending on the level of initial physical condition and examination results. All trainings were carried out under the control of pulse, blood pressure and oxygen saturation. The duration of the course was 14 days.
Results. After the course of rehabilitation treatment, there was a positive trend according to the data of the cardiorespiratory test in the form of an increase in the performed load, the anaerobic threshold, and the peak VO2. According to spirometry data, there was an increase in the maximum voluntary ventilation of the lungs. According to the biochemical analysis of blood, 50% of the patients showed a decrease in the level of total bilirubin; according to ultrasound data, normalization of liver size was noted in all children.
Conclusion. The implementation of this complex is a safe and effective way to rehabilitate children in the long-term period after a Fontan procedure. However, this topic requires further study and observation in a more distant period to assess the effectiveness of the ongoing rehabilitation measures.
References
- Aronov D.M. Fundamentals of cardiac rehabilitation. Cardiology: news, opinions, training. 2016; 10 (3): 104–10 (in Russ.).
- Mustafina (Yakubova) L.I., Putyato N.A., Zavarina A.Yu., Shvedunova V.N., Pashik S.P., Boos D.A. Method for the rehabilitation of children in the long-term period after surgical correction of congenital heart disease by a Fontan procedure. Patent of the Bakoulev National Medical Research Center for Cardiovascular Surgery of Ministry of Health of the Russian Federation; 2019, 29–9 (in Russ.).
- Lebedev V.P., Trusov S.V., Grinenko A.Ya, Krupitskiy E.M., Burakov A.M. The use of transcranial electrical stimulation in narcology. Methodical recommendations. 2015 (in Russ.).
- Zomer A.C., Vaartjes I., Van der Velde E.T., Y de Jong H.M., Konings T.C., Wagenaar L.J. Heart failure admissions in adults with congenital heart disease; risk factors and prognosis. J. Cardiol. 2013; 168: 2487–93. DOI: 10.1016/j.ijcard. 2013.03.003 Children’s Heart and Vascular Diseases. 2021; 18 (3) DOI: 10.24022/1810-0686-2021-18-3-199-204 Original articles 204
- Duppen N., Etnel J.R., Spaans L., Takken T., Van den BergEmons R.J., Boersma E. et al. Does exercise training improve cardiopulmonary fitness and daily physical activity in children and young adults with corrected tetralogy of Fallot or Fontan circulation? A randomized controlled trial. Am. Heart J. 2015; 170: 606–14. DOI: 10.1016/j.ahj.2015.06.018
- Sutherland N., Jones B., D'Udekem Y. Should we recommend exercise after the Fontan procedure? Heart Lung Circ. 2015; 24 (8): 753–68. DOI: 10.1016/j.hlc.2015.03.005 7. Takken T., Hulzebos H.J., Blank A.C., Tacken M.H.P., Helders P.J., Strengers J.L.M. Exercise prescription for patients with a Fontan circulation: current evidence and future directions. Neth. Heart J. 2007; 15 (4): 142–7. DOI: 10.1007/BF03085970
- Shimizu M., Miyamoto K., Nishihara Y., Izumi1 G., Sakai S., Ina K. et al. Risk factors and serological markers of liver cirrhosis after Fontan procedure. Heart Vessels. 2016; 31 (9): 1514–21. DOI: 10.1007/s00380-015-0743-4
- Giardini A., Hager A., Napoleone C.P. Picchio F.M. Natural history of exercise capacity after the Fontan operation: a longitudinal study. Ann. Thorac. Surg. 2008; 85 (3): 818–21. DOI: 10.1016/j.athoracsur.2007.11.009
- Amedro P., Gavotto A., Guillaumont S., Bertet H., Vincenti M., De la Villeon G. et al. Cardiopulmonary fitness in children with congenital heart diseases versus healthy children. Heart. 2018; 104 (12): 1026–36. DOI: 10.1136/heartjnl-2017-312339
- Brassard P., Be′dard E′ ., Jobin J., Rode′s-Cabau J., Poirier P. Exercise capacity and impact of exercise training in patients after a Fontan procedure: A review. Can. J. Cardiol. 2006; 22 (6): 489–95. DOI: 10.1016/s0828-282x (06)70266-5
- Исмаилбаев А.М., Астраханцева Т.О. Отдаленные результаты операции Фонтена в модификации эктракрдиального кондуита. Сердечно-сосудистые заболевания. Бюллетень НЦССХ им. А.Н. Бакулева РАМН. 2014; 15 (6): 19–29. Ismailbaev А.М., Astrakhantseva T.O. Long-term r esults of the Fontaine operation in the modification of an extracardial conduit. The Bulletin of Bakoulev Center for Cardiovascular Diseases. 2014; 15 (6): 19–29 (in Russ.).
- Bezuska L., Lebetkevicius V., Sudikiene R. 30-year experience of Fontan surgery: single-centre`s data. J. Cardiothorac. Surg. 2017; 12 (1): 67. DOI: 10.1186/1749-8090-10-S1-A121
- Amedro P., Gavotto A., Bredy Ch., Guillaumont S. Cardiac rehabilitation for children and adults with congenital heart disease. Presse Med. 2017; 46 (5): 530–7. DOI: 10.1016/j.lpm.2016.12.001
- Kiseleva M.G. Psychological characteristics of childrenof the second year of life with congenital heart disease. The Bulletin of Bakoulev Center for Cardiovascular Diseases. 2017; 18 (5): 501–6. DOI: 10.24022/1810-0694-2017-18-5-501-506 (in Russ.).
About the authors
- Leysan I. Yakubova, Pediatrician, Pediatric Cardiologist; ORCID
- Niyole A. Putyato, Cand. Med. Sci., Head of Department, ORCID
- Anna Yu. Zavarina, Chief Physician of the Children's Rehabilitation Center, ORCID
- Valentina N. Shvedunova, Dr. Med. Sci., Professor, Head of Department, ORCID
- Flora A. Barseyan, Functional Diagnostician, ORCID
- Danila A. Boos, Doctor of Physical Therapy and Physiotherapy; ORCID
- Elena M. Savova, Doctor of Physical Therapy and Sports Medicine; ORCID
- Mark A. Zatenko, Physical Therapy Instructor; ORCID
- Lyudmila A. Glushko, Cand. Med. Sci., Head of the Group of Pulmonary Samples and Monitoring of Gas Exchange, Cardiologist; ORCID
