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Original title:
Atem - Training bei Kindern und Jugendlichen mit univentrikulärem Herzen nach palliativer TCPC Operation 
Translated title:
Ventilatory training in children and young adolescents with univentricular hearts after palliative TCPC surgery 
Document type:
Fakultät für Sport- und Gesundheitswissenschaften 
Oberhoffer, Renate (Prof. Dr.) 
Oberhoffer, Renate (Prof. Dr.); Kaemmerer, Harald (Prof. Dr. Dr.) 
Subject group:
MED Medizin; SPO Sport 
Atemtraining, Univentrikuläres Herz, TCPC Operation 
Translated keywords:
Ventilatory Training, Fontan Operation, Univentricular Hearts 
TUM classification:
SPO 630d; MED 670d 
Seit Einführung der Fontan-Operation im Jahre 1968 haben weltweit viele tausend Patienten mit morphologisch oder funktionell univentrikulärem Herzen (UVH), einen derartigen Eingriff erhalten. Gegenüber der präoperativen Situation profitieren Patienten mit UVH insbesondere hinsichtlich ihrer körperlichen Belastbarkeit und Belastungsdauer von einer Fontan-Operation. Trotz aller Fortschritte der modernen Medizin und sinkender Letalität sind die Patienten nach Fontan-Operation durch diesen Eingriff...    »
Translated abstract:
Since the introduction of the Fontan operation in 1968, worldwide many thousands of patients with a morphologically or functionally univentricular heart have received a total cavopulmonary connection (TCPC). Compared to the preoperative situation, patients with a univentricular heart after Fontan operation have experienced the benefit in regard to their physical capacity. Despite all advances of modern medicine and the declining mortality in this population, patients after Fontan operation are not cured. From various studies it is known that the physical performance of Fontan- / TCPC patients has declined to 50-60% of their peers. Because of exercise limitations as well as health and psychological problems, it is important to intervene early in preventive and / or rehabilitative care. Based on current data, exercise training can improve performance as well as cardiopulmonary function and an improvement can be expected for the long-term course. Whether or not a breathing training can also improve exercise performance after TCPC operation has not been tested yet. The present study deals with the impact of a home respiratory training, aiming to strengthen respiratory muscles, improve lung function and the peripheral oxygen supply, in order to increase physical performance. For the very first time, in a relatively large cohort of 40 consecutive patients with a Fontan circulation (TCPC), aging 8 to 17 years (female 25%), the effects of respiratory training on lung capacity and exercise performance were measured. In the training group, physical performance increased on average by 14%, from 123 to 140 watts after a respiratory training. In the control group exercise performance increased only 6.5% (from 111 to 119 watts). After respiratory training, in the training group there was an 10% increase in the forced vital capacity (FVC) from 2.58 ± 0.75 to 2.84 ± 0.75 liters, in the control group an 11% increase (from 2.3 ± 0.79 to 2.57 ± 0.87 liters). In the training group VO2peak increased after respiratory training by 3.0% (from 35.7 ± 6.9 to 36.8 ± 7.7 ml/kg/min), in the control group by 2.7% of 33,0 ± 5.8 to 33.9 ± 6.4 ml/kg/min. A positive, statistically significant effect was found in oxygen saturation at rest. At the end of the study period the oxygen saturation at rest was significantly higher in the exercise group compared to the control group (p < .014). In addition, the mean oxygen saturation during exercise did not decrease below 90% in the training group. This might be due to a better organ perfusion and may possibly reduce the risk of a systemico-arterial embolism as part of a right-left shunt. Moreover, after the six month period of respiratory training, physical performance increased by an average of 14%, vital capacity by 10% and VO2peak increased by only 3%. A statistically significant difference could, however, not be found after adjustment of the output values of the parameters between training and control groups. The results of this study show that benefits from a breathing training can be expected. Even if some data are not statistically significant, they may still be clinically relevant and may contribute to a multidisciplinary approach in patient care. Breathing training should therefore be an additional target and integrated into the training program to improve the prognosis of patients with TCPC. Further studies are certainly needed in order to improve the effectiveness of prophylactic measures and to document long-term effects. 
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