Аннотация
Известно, что программы кардиореабилитации для детей с врожденными пороками сердца (ВПС) являются безопасными, эффективными и могут поддерживать эффекты хирургических вмешательств. Однако до настоящего времени оптимальные программы реабилитации детей с ВПС не разработаны. В статье проанализированы проблемы отдаленного периода у детей, оперированных по поводу коарктации аорты (КоА), особенности их динамического наблюдения и подходы к назначению программы реабилитации. Сделан вывод о необходимости тщательного контроля состояния здоровья на протяжении всей жизни и проведения реабилитационных мероприятий, индивидуально разработанных для каждого ребенка. Комплексная программа реабилитации должна включать мероприятия по улучшению физических, психологических и социальных аспектов у детей, чтобы снизить риски возможных осложнений и улучшить качество жизни. Разработка реабилитационных программ для пациентов после хирургического лечения КоА должна улучшить и долгосрочные перспективы этой категории пациентов, такие как устранение факторов риска развития сердечно-сосудистых заболеваний, снижение инвалидизации, заболеваемости и смертности.
Литература
- Thomas R.J., Beatty A.L., Beckie T.M., Brewer L.C., Brown T.M., Forman D.E. et al. Home-based cardiac rehabilitation: a scientific statement from the American Association of Cardiovascular and Pulmonary Rehabilitation, the American Heart Association, and the American College of Cardiology. Circulation. 2019; 140 (1): 69–89. DOI: 10.1161/CIR.0000000000000663
- Takken T., Giardini A., Reybrouck T., Gewillig M., Hövels-Gürich H.H., Longmuir P.E. et al. Recommendations for physical activity, recreation sport, and exercise training in paediatric patients with congenital heart disease: a report from the Exercise, Basic & Translational Research Section of the European Association of Cardiovascular Prevention and Rehabilitation, the European Congenital Heart and Lung Exercise Group, and the Association for European Paediatric Cardiology. Eur. J. Prev. Cardiol. 2012; 19 (5): 1034–65. DOI: 10.1177/1741826711420000
- Кассирский Г.И., Рогова Т.В., Иванова О.И., Ремезова Т.С., Неведрова М.Н., Базилевич М.С. Клинико-функциональная оценка состояния детей, оперированных по поводу коарктации аорты на первом году жизни. Детские болезни сердца и сосуд дов. 2010; 3: 19–23.
- Бокерия Л.А., Милиевская Е.Б., Крупянко С.М., Тамазян Г.В., Осипова Г.Р. Врожденные пороки сердца: актуальные вопросы организации реабилитационной помощи. М.: НЦССХ им. А.Н. Бакулева; 2015.
- Rosenthal E. Coarctation of the aorta from fetus to adult: curable condition or life long disease process? Heart. 2005; 91 (11): 1495–502. DOI: 10.1136/hrt.2004.057182
- Bambul Heck P., Pabst von Ohain J., Kaemmerer H., Ewert P., Hager A. Survival and cardiovascular events after coarctation-repair in long-term follow-up (COAFU): Predictive value of clinical variables. Int. J. Cardiol. 2017; 228: 347–51. DOI: 10.1016/j.ijcard. 2016.11.164
- Stout K.K., Daniels C.J., Aboulhosn J.A., Bozkurt B., Broberg C.S., Colman J.M. et al. 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J. Am. Coll. Cardiol. 2019; 73 (12): 81–192. DOI: 10.1016/j.jacc.2018.08.1029
- Dijkema E.J., Leiner T., Grotenhuis H.B. Diagnosis, imaging and clinical management of aortic coarctation. Heart. 2017; 103 (15): 1148–55. DOI: 10.1136/heartjnl2017-311173
- Dempsey A.A., Parraga G., Altamirano-Diaz L., Welisch E., Park T.S., Grattan M. et al. Increased blood pressure is associated with increased carotid artery intima-media thickness in children with repaired coarctation of the aorta. J. Hypertens. 2019; 37 (8): 1689–98. DOI: 10.1097/HJH.0000000000002077
- Vriend J.W., Mulder B.J. Late complications in patients after repair of aortic coarctation: implications for management. Int. J. Cardiol. 2005; 101 (3): 399–406. DOI: 10.1016/j.ijcard.2004.03.056
- Agˇbas, A., Gökalp S., Canpolat N., C, alıs,kan S., Öztunc, F. Is the burden of late hypertension and cardiovascular target organ damage in children and adolescents with coarctation of the aorta after early successful repair different to healthy controls? Cardiol. Young. 2020; 30 (9): 1305–12. DOI: 10.1017/S104795112000205X
- Luijendijk P., Bouma B.J., Vriend J.W., Vliegen H.W., Groenink M., Mulder B.J. Usefulness of exerciseinduced hypertension as predictor of chronic hypertension in adults after operative therapy for aortic isthmic coarctation in childhood. Am. J. Cardiol. 2011; 108 (3): 435–9. DOI: 10.1016/j.amjcard.2011.03.063
- Kaafarani M., Schroer C., Takken T. Reference values for blood pressure response to cycle ergometry in the first two decades of life: comparison with patients with a repaired coarctation of the aorta. Expert. Rev. Cardiovasc. Ther. 2017; 15 (12): 945–51. DOI: 10.1080/14779072.2017. 1385392
- Lee M.G.Y., Hemmes R.A., Mynard J., Lambert E., Head G.A., Cheung M.M.H. et al. Elevated sympathetic activity, endothelial dysfunction, and late hypertension after repair of coarctation of the aorta. Int. J. Cardiol. 2017; 243: 185–90. DOI: 10.1016/j.ijcard.2017.05.075
- Cetiner N., Erolu E., Baran Him N., S, aylan C, evik B., Akalın F. Vascular wall changes and arterial functions in children with surgically repaired aortic coarctation. Turk. Arch. Pediatr. 2022; 57 (2): 193–9. DOI: 10.5152/TurkArchPediatr.2022.21236
- Donazzan L., Crepaz R., Stuefer J., Stellin G. Abnormalities of aortic arch shape, central aortic flow dynamics, and distensibility predispose to hypertension after successful repair of aortic coarctation. World J. Pediatr. Congenit. Heart Surg. 2014; 5 (4): 546–53. DOI: 10.1177/2150135114551028
- Wu M.H., Chen H.C., Kao F.Y., Huang S.K. Risk of systemic hypertension and cerebrovascular accident in patients with aortic coarctation aged <60 years (from a National Database Study). Am. J. Cardiol. 2015; 116 (5): 779–84. DOI: 10.1016/j.amjcard.2015.05.052
- Ремезова Т.С. Отдаленные результаты хирургического лечения коарктации аорты у детей грудного возраста. Детские болезни сердца и сосудов. 2011; 1: 31–6.
- Yogeswaran V., Connolly H.M., Al-Otaibi M., Ammash N.M., Warnes C.A., Said S.M., Egbe A.C. Prognostic role of hypertensive response to exercise in patients with repaired coarctation of aorta. Can. J. Cardiol. 2018; 34 (5): 676–82. DOI: 10.1016/j.cjca. 2018.02.004
- Buys R., Van De Bruaene A., Müller J., Hager A., Khambadkone S., Giardini A. et al. Usefulness of cardiopulmonary exercise testing to predict the development of arterial hypertension in adult patients with repaired isolated coarctation of the aorta. Int. J. Cardiol. 2013; 168 (3): 2037–41. DOI: 10.1016/j.ijcard.2013.01.171
- Lurbe E., Agabiti-Rosei E., Cruickshank J.K., Dominiczak A., Erdine S., Hirth A. et al. 2016 European Society of Hypertension guidelines for the management of high blood pressure in children and adolescents. J. Hypertens. 2016; 34 (10): 1887–920. DOI: 10.1097/HJH.0000000000001039
- Vigneswaran T.V., Sinha M.D., Valverde I., Simpson J.M., Charakida M. Hypertension in coarctation of the aorta: challenges in diagnosis in children. Pediatr. Cardiol. 2018; 39 (1): 1–10. DOI: 10.1007/s00246-017-1739-x
- Сойнов И.А., Архипов А.Н., Кулябин Ю.Ю., Горбатых Ю.Н., Корнилов И.А., Омельченко А.Ю., Богачев-Прокофьев А.В. Артериальная гипертензия у детей после коррекции коарктации аорты: проблемы диагностики и лечения. Патология кровообращения и кардиохирургия. 2018; 22 (4): 21–34. DOI: 10.21688- 1681-3472-2018-4-21-34
- Lehnert A., Villemain O., Gaudin R., Méot M., Raisky O., Bonnet D. Risk factors of mortality and recoarctation after coarctation repair in infancy. Interact. Cardiovasc. Thorac. Surg. 2019; 29 (3): 469–75. DOI: 10.1093/icvts/ivz117
- Туманян М.Р., Свободов А.А., Левченко Е.Г., Андерсон А.Г., Макаренко М.В. Кардиологические проблемы в отдаленном периоде у детей после устранения на первом году жизни коарктации аорты. Педиатрия. 2018; 97 (3): 24–8. DOI: 10.24110/0031-403X-2018-97-3-24-28
- Von Kodolitsch Y., Aydin A.M., Bernhardt A.M., Habermann C., Treede H., Reichenspurner H. et al. Aortic aneurysms after correction of aortic coarctation: a systematic review. Vasa. 2010; 39 (1): 3–16. DOI: 10.1024/0301-1526/a000001
- Gati S., Malhotra A., Sharma S. Exercise recommendations in patients with valvular heart disease. Heart. 2019; 105 (2): 106–10. DOI: 10.1136/heartjnl-2018-313372
- 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
- Pedersen T.A., Munk K., Andersen N.H., Lundorf E., Pedersen E.B., Hjortdal V.E., Emmertsen K. High longterm morbidity in repaired aortic coarctation: weak association with residual arch obstruction. Congenit. Heart Dis. 2011; 6 (6): 573–82. DOI: 10.1111/j.1747-0803.2011.00575.x
- Diller G.P., Dimopoulos K., Okonko D., Li W., BabuNarayan S.V., Broberg C.S. et al. Exercise intolerance in adult congenital heart disease: comparative severity, correlates, and prognostic implication. Circulation. 2005; 112 (6): 828–35. DOI: 10.1161/CIRCULATIONAHA.104.529800
- Dijkema E.J., Sieswerda G.T., Breur J.M.P.J., Haas F., Slieker M.G., Takken T. Exercise capacity in asymptomatic adult patients treated for coarctation of the aorta. Pediatr. Cardiol. 2019; 40 (7): 1488–93. DOI: 10.1007/s00246-019-02173-5
- Bjarnason-Wehrens B., Dordel S., Schickendantz S., Krumm C., Bott D., Sreeram N., Brockmeier K. Motor development in children with congenital cardiac diseases compared to their healthy peers. Cardiol. Young. 2007; 17 (5): 487–98. DOI: 10.1017/S1047951107001023
- Róg B., Okólska M., Weryński P., Wilkołek P., Pawelec T., Pająk J. et al. Long-term observation of adults after successful repair of aortic coarctation. Postepy. Kardiol. Interwencyjnej. 2019; 15 (4): 455–64. DOI: 10.5114/aic.2019.90220
- Rhodes J., Geggel R.L., Marx G.R., Bevilacqua L., Dambach Y.B., Hijazi Z.M. Excessive anaerobic metabolism during exercise after repair of aortic coarctation. J. Pediatr. 1997; 131 (2): 210–4. DOI: 10.1016/s0022-3476(97)70155-0
- Eriksson B.O., Hanson E. Muscle metabolism during exercise in men operated upon for coarctation of the aorta in childhood. Scand. J. Clin. Lab. Invest. 1981; 41 (2): 135–41. DOI: 10.3109/00365518109092025
- Ким А.И., Рогова Т.В., Верещагина А.М., Машина Т.В. Коарктация аорты: нуждается ли пациент, оперированный в раннем возрасте, в дальнейшем наблюдении? Креативная кардиология. 2015; 1: 46–52. DOI: 10.15275/kreatkard.2015.01.05
- Maciver D.H., Townsend M. A novel mechanism of heart failure with normal ejection fraction. Heart. 2008; 94 (4): 446–9. DOI: 10.1136/hrt.2006.114082 38. Huang S.J., Orde S. From speckle tracking echocardiography to torsion: research tool today, clinical practice tomorrow. Curr. Opin. Crit. Care. 2013; 19 (3): 250–7. DOI: 10.1097/MCC.0b013e32836092b7
- Egbe A.C., Qureshi M.Y., Connolly H.M. Determinants of left ventricular diastolic function and exertional symptoms in adults with coarctation of aorta. Circ. Heart Fail. 2020; 13 (2): 006651. DOI: 10.1161/CIRCHEARTFAILURE.119.006651
- Kutty S., Rangamani S., Venkataraman J., Li L., Schuster A., Fletcher S.E. et al. Reduced global longitudinal and radial strain with normal left ventricular ejection fraction late after effective repair of aortic coarctation: a CMR feature tracking study. Int. J. Cardiovasc. Imaging. 2013; 29 (1): 141–50. DOI: 10.1007/s10554- 012-0061-1
- Di Salvo G., Pacileo G., Limongelli G., Verrengia M., Rea A., Santoro G. et al. Abnormal regional myocardial deformation properties and increased aortic stiffness in normotensive patients with aortic coarctation despite successful correction: an ABPM, standard echocardiography and strain rate imaging study. Clin. Sci. (Lond.). 2007; 113 (5): 259–66. DOI: 10.1042/CS20070085
- Keshavarz-Motamed Z., Garcia J,. Kadem L. Fluid dynamics of coarctation of the aorta and effect of bicuspid aortic valve. PLoS. One. 2013; 8 (8): 72394. DOI: 10.1371/journal.pone.0072394 43. Florianczyk T., Werner B. Assessment of left ventricular diastolic function in children after successful repair of aortic coarctation. Clin. Res. Cardiol. 2011; 100 (6): 493–9. DOI: 10.1007/s00392-010-0272-1
- Юрпольская Л.А., Шляппо М.А., Левченко Е.Г., Макаренко В.Н., Свободов А.А., Макаренко М.В., Поромов А.А. 4D FLOW магнитно-резонансная томография в изучении кровотока у пациентов с коарктацией аорты в отдаленные сроки после операции. Кардиология. 2020; 60 (8): 54–64 (in Russ.). DOI: 10.18087/cardio.2020.8.n1094
- Liu J., Drak D., Krishnan A., Chen S.Y., Canniffe C., Bao S. et al. Left ventricular fibrosis and systolic hypertension persist in a repaired aortic coarctation model. Ann. Thorac. Surg. 2017; 104 (3): 942–9. DOI: 10.1016/j.athoracsur.2017.02.027
- Bambul Heck P., Pabst von Ohain J., Kaemmerer H., Ewert P., Hager A. Quality of life after surgical treatment of coarctation in long-term follow-up (CoAFU): Predictive value of clinical variables. Int. J. Cardiol. 2018; 250: 116–9. DOI: 10.1016/j.ijcard.2017.10.024
- Moons P., Luyckx K., Thomet C., Budts W., Enomoto J., Sluman M.A. et al. APPROACH-IS Consortium and the International Society for Adult Congenital Heart Disease (ISACHD). Physical functioning, mental health, and quality of life in different congenital heart defects: comparative analysis in 3538 patients from 15 countries. Can. J. Cardiol. 2021; 37 (2): 215–23. DOI: 10.1016/j.cjca.2020.03.044
- Müller J., Hess J., Hager A. Minor symptoms of depression in patients with congenital heart disease have a larger impact on quality of life than limited exercise capacity. Int. J. Cardiol. 2012; 154 (3): 265–9. DOI: 10.1016/j.ijcard.2010.09.029
- Algra S.O,. Jansen N.J., van der Tweel I., Schouten A.N., Groenendaal F., Toet M. et al. Neurological injury after neonatal cardiac surgery: a randomized, controlled trial of 2 perfusion techniques. Circulation. 2014; 129 (2): 224–33. DOI: 10.1161/CIRCULATIONAHA. 113.003312
- Marino B.S., Lipkin P.H., Newburger J.W., Peacock G., Gerdes M., Gaynor J.W. et al. American Heart Association Congenital Heart Defects Committee, Council on Cardiovascular Disease in the Young, Council on Cardiovascular Nursing, and Stroke Council. Neurodevelopmental outcomes in children with congenital heart disease: evaluation and management: a scientific statement from the American Heart Association. Circulation. 2012; 126 (9): 1143–72. DOI: 10.1161/CIR.0b013e318265ee8a
- Egbe A.C., Padang R., Brown R.D., Khan A.R., Luis S.A., Huston J. et al. Prevalence and predictors of intracranial aneurysms in patients with bicuspid aortic valve. Heart. 2017; 103 (19): 1508–14. DOI: 10.1136/heartjnl-2016- 311076
- Пономаренко Г.Н. (ред.). Физическая и реабилитационная медицина. Национальное руководство. М.: ГЭОТАР-Медиа; 2020. Ponomarenko G.N. (Ed.) Physical and rehabilitation medicine. National Guide. Moscow; 2020.
- Duppen N., Takken T., Hopman M.T., ten Harkel A.D., Dulfer K., Utens E.M., Helbing W.A. Systematic review of the effects of physical exercise training programmes in children and young adults with congenital heart disease. Int. J. Cardiol. 2013; 168 (3): 1779–87. DOI: 10.1016/j.ijcard.2013.05.086
- Caterini J.E., Campisi E.S., Cifra B. Physical activity promotion in pediatric congenital heart disease: are we running late? Can. J. Cardiol. 2020; 36 (9): 1406–16. DOI: 10.1016/j.cjca.2020.07.003
- Longmuir P.E., Brothers J.A., de Ferranti S.D., Hayman L.L., Van Hare G.F, Matherne G.P. et al. American Heart Association Atherosclerosis, Hypertension and Obesity in Youth Committee of the Council on Cardiovascular Disease in the Young. Promotion of physical activity for children and adults with congenital heart disease: a scientific statement from the American Heart Association. Circulation. 2013; 127 (21): 2147–59. DOI: 10.1161/CIR.0b013e318293688f
- Foulds H.J.A., Giacomantonio N.B., Bredin S.S.D., Warburton D.E.R. A systematic review and meta-analysis of exercise and exercise hypertension in patients with aortic coarctation. J. Hum. Hypertens. 2017; 31 (12): 768–75. DOI: 10.1038/jhh.2017.55
- Zaqout M., Vandekerckhove K., De Wolf D., Panzer J., Bové T., Franc,ois K. et al. Determinants of physical fitness in children with repaired congenital heart disease. Pediatr. Cardiol. 2021; 42 (4): 857–65. DOI: 10.1007/s00246-021-02551-y
- Zoller T., Prioli M.A., Clemente M., Pilati M., Sandrini C., Luciani G.B. et al. Congenital heart disease: growth evaluation and sport activity in a paediatric population. Children (Basel). 2022; 9 (6): 884. DOI: 10.3390/children9060884
- Smith-Parrish M., Sunkyung Yu.S., Rocchini A. Obesity and elevated blood pressure following repair of coarctation of the aorta. J. Pediatr. 2014; 164 (5): 1074–8. DOI: 10.1016/j.jpeds.2014.01.043
- Ho M., Garnett S.P., Baur L., Burrows T., Stewart L., Neve M., Collins C. Effectiveness of lifestyle interventions in child obesity: systematic review with meta-analysis. Pediatrics. 2012; 130 (6): 1647–71. DOI: 10.1542/peds.2012-1176
- Barradas-Pires A., Constantine A., Dimopoulos K. Safety of physical sports and exercise in ACHD. Int. J. Cardiol. Congenit. Heart Dis. 2021; 4: 100151. DOI: 10.1016/j.ijcchd.2021.100151
- Amedro P., Gavotto A., Legendre A., Lavastre K., Bredy C., De La Villeon G. et al. Impact of a centre and home-based cardiac rehabilitation program on the quality of life of teenagers and young adults with congenital heart disease: The QUALI-REHAB study rationale, design and methods. Int. J. Cardiol. 2019; 283: 112–8. DOI: 10.1016/j.ijcard.2018.12.050
Об авторах
- Заварина Анна Юрьевна, главный врач Реабилитационного центра для детей с пороками сердца; ORCID
- Рогова Татьяна Владимировна, д-р мед. наук, заведующий отделением; ORCID
- Шведунова Валентина Николаевна, д-р мед. наук, профессор, заведующий отделением; ORCID
- Глушко Людмила Александровна, канд. мед. наук, заведующий отделением; ORCID
- Боос Данила Александрович, врач лечебной физкультуры; ORCID