Amedro Pascal, Gavotto Arthur, Bredy Charlène, Guillaumont Sophie
CHU de Montpellier, centre de compétences M3C, cardiologie pédiatrique et congénitale, Montpellier, France; Université de Montpellier, PHYMEDEXP, UMR CNRS 9214, Inserm U1046, laboratoire de physiologie et médecine expérimentale du cœur et des muscles, Montpellier, France.
CHU de Montpellier, centre de compétences M3C, cardiologie pédiatrique et congénitale, Montpellier, France; Université de Montpellier, PHYMEDEXP, UMR CNRS 9214, Inserm U1046, laboratoire de physiologie et médecine expérimentale du cœur et des muscles, Montpellier, France.
Presse Med. 2017 May;46(5):530-537. doi: 10.1016/j.lpm.2016.12.001. Epub 2017 Jan 23.
Advances in heart surgery over the past 30 years have significantly improved the prognosis of congenital heart diseases (CHD). Therefore, the epidemiology of CHD has changed dramatically with a shift of mortality from pediatrics to adulthood and an increased prevalence of complex CHD. Today, caregivers and patients focus their interests to new perspectives: improving the quality of life, practicing sports, improving psychosocial care. Cardiac rehabilitation is completely integrated in these new therapeutic strategies. The starting point is the cardiopulmonary exercise test (CPET), with the measurement of oxygen uptake, or "VO2". CPET is now recommended in the follow-up of the adults with CHD. Maximum oxygen uptake correlates to the quality of life of children and adults with CHD. The principles of the rehabilitation in patients with heart failure may usually be applied to CHD patients. Some studies in complex CHD showed improvement of VO2 and quality of life after rehabilitation, without any adverse events. However few physicians have the experience in rehabilitation among CHD patients, especially children. Randomized trials on cardiac rehabilitation in adult and pediatric CHD patients are essential to increase the level of evidence and lead to specific guidelines in this population.
在过去30年中，心脏外科手术的进展显著改善了先天性心脏病（CHD）的预后。因此，CHD的流行病学发生了巨大变化，死亡率从儿科向成人转移，复杂CHD的患病率增加。如今，护理人员和患者将兴趣点转向了新的方面：提高生活质量、进行体育锻炼、改善心理社会护理。心脏康复已完全融入这些新的治疗策略中。起点是心肺运动试验（CPET），通过测量摄氧量，即“VO₂”。目前，CPET被推荐用于CHD成人患者的随访。最大摄氧量与CHD儿童和成人的生活质量相关。心力衰竭患者的康复原则通常也适用于CHD患者。一些针对复杂CHD的研究表明，康复后VO₂和生活质量有所改善，且无任何不良事件。然而，很少有医生具备CHD患者（尤其是儿童）康复方面的经验。针对成人和儿科CHD患者进行心脏康复的随机试验对于提高证据水平并制定该人群的具体指南至关重要。
