Effect of physical training after pulmonary valve implantation in adolescents and adults with Tetralogy of Fallot operated

• Grant number: 23/12680-8
• Support Opportunities: Regular Research Grants
• Start date: July 01, 2024
• End date: June 30, 2026
• Field of knowledge: Health Sciences - Medicine - Surgery
• Principal Investigator: Luiz Fernando Canêo
• Grantee: Luiz Fernando Canêo
• Host Institution: Instituto do Coração Professor Euryclides de Jesus Zerbini (INCOR). Hospital das Clínicas da Faculdade de Medicina da USP (HCFMUSP). Secretaria da Saúde (São Paulo - Estado). São Paulo , SP, Brazil
• Associated researchers: Aída Luiza Ribeiro Turquetto ; Fabio Biscegli Jatene ; Francis Ribeiro de Souza ; Luciana Patrick Amato ; Marcelo Biscegli Jatene ; Maria Janieire de Nazaré Nunes Alves ; Melissa Ganeko Ligeiro
• Associated scholarship(s): 25/07682-7 - Follow-up of patients' body composition-related tests., BP.TT; 24/17333-7 - Recruitment and scheduling of patients and the monitoring of the exams performed in the research protocol., BP.TT

Abstract

Introduction: Adult patients in the late postoperative period of Tetralogy of Fallot (TF) are at risk for severe pulmonary insufficiency in the medium and long term. Although pulmonary valve insufficiency is tolerated, these patients require reoperation within 30 years for pulmonary valve implantation (PVI) due to progressive right ventricular dilation and dysfunction, causing left ventricular dysfunction by electromechanical dyssynchrony. Although they present improvement in ventricular volumes and function after PVI, little improvement has been demonstrated in the functional capacity of these patients, on the other hand, physical training seems to be effective in improving this parameter.Methodology: Clinical, prospective, longitudinal, controlled study. Patients of both genders, age e 16 years, in late postoperative period of TF correction with severe pulmonary insufficiency, admitted for PVI. In the preoperative period of hospital admission to perform PVI, the patient will be invited to participate in the study. The preoperative analysis will include data from Cardiovascular Magnetic Resonance (CMR), Echocardiogram (ECHO) and Cardiopulmonary Test (CPT), and to complement the research data, the following will be performed: six-minute walk test (6MWT), evaluation of the level of physical activity by the IPAQ physical activity inventory, quality of life by the SF-36 questionnaire (QoL), 24-hour Holter, Bioimpedance and Handgrip. After hospital discharge the patient will be reassessed by means of: ECO, CPT, Holter, TC6min, QL, Bioimpedance and Handgrip. The patient will be released to perform the training protocol after evaluation by the cardiologist responsible for the study. Once released, the patient will be selected for the physical training group, where he/she will undergo a period of 36 sessions of supervised aerobic training (3 months) or for the non-training control group, where the patient will spend the equivalent of 3 months in clinical follow-up. Both groups after the determined period will go through the reevaluation of the exams: CMR, ECHO, CPT, Holter, TC6min, Bioimpedance, Handgrip, and QL. Expected results: We hope to demonstrate that after PVI, physical training is able to improve functional capacity and body composition, as well as reduce volumes and increase ventricular function in patients with severe pulmonary regurgitation in late postoperative of TF. (AU)