Why Exercise Capacity Does Not Improve After Pulmonary Valve Replacement

Lauren E. Sterrett, Eric S. Ebenroth, Christina Query, Jason Ho, Gregory S. Montgomery, Roger A. Hurwitz, Fitsum Baye, Marcus S. Schamberger

Research output: Contribution to journalArticle

6 Scopus citations


Optimal timing of pulmonary valve replacement (PVR) for pulmonary regurgitation is a debated topic. It is logical that maximal aerobic capacity (VO<inf>2peak</inf>) would decline when a PVR is needed, but a diminished VO<inf>2peak</inf> is not always present before PVR, and previous studies show no improvement in VO<inf>2peak</inf> after PVR. This study aimed to evaluate changes in resting spirometry from pre- to post-PVR sternotomy, to determine the limiting factors of VO<inf>2peak</inf> before and after PVR, and to determine whether changes in resting lung function after PVR may explain the lack of improvement in VO<inf>2peak</inf> after surgery. For 26 patients (age, 19.7 ± 7.8 years) with a history of right ventricular outflow tract revision, the study prospectively evaluated echocardiograms, resting spirometry, and maximal exercise tests before PVR and then an average of 15 months after PVR. Flow volume loops were reviewed by a pulmonologist and categorized as obstructive, restrictive, both obstructive and restrictive, or normal. Exercise tests were interpreted using Eschenbacher’s algorithm to determine the primary factors limiting exercise. No change in VO<inf>2peak</inf> or spirometry after PVR was observed. Before PVR, many patients had abnormal resting lung functions (85 % abnormal), which was unchanged after PVR (86 5 % abnormal). The majority of the patients had a ventilatory limitation to VO<inf>2peak</inf> before PVR (66.7 %), whereas 28.5 % had a cardiovascular limitation, and 4.8 % had no clear limitation. After PVR, 65.2 % of the patients had a ventilatory limitation, whereas 30.4 % had a cardiovascular limitation, and 4.4 % had no clear limitation to VO<inf>2peak</inf>. Pulmonary function did not change up to 15 months after surgical PVR. The frequency of pulmonary limitation to VO<inf>2peak</inf> after PVR did not increase. The effect of pulmonary function on exercise-related symptoms must be considered in this patient population. Improved cardiac hemodynamics are unlikely to improve VO<inf>2peak</inf> in a primarily pulmonary-limited patient.

Original languageEnglish (US)
Pages (from-to)1395-1402
Number of pages8
JournalPediatric Cardiology
Issue number8
StatePublished - Jan 1 2014


  • Exercise capacity
  • Lung function
  • Pulmonary insufficiency
  • Spirometry
  • Tetralogy of fallot
  • VO<inf>2peak</inf>

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pediatrics, Perinatology, and Child Health

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  • Cite this

    Sterrett, L. E., Ebenroth, E. S., Query, C., Ho, J., Montgomery, G. S., Hurwitz, R. A., Baye, F., & Schamberger, M. S. (2014). Why Exercise Capacity Does Not Improve After Pulmonary Valve Replacement. Pediatric Cardiology, 35(8), 1395-1402. https://doi.org/10.1007/s00246-014-0942-2