Sport for children and adolescents with congenital heart defects
When caring for children and adolescents with congenital heart defects, the question often arises about the possibility of participating in physical education or choosing recreational sports. This article is intended to provide an overview of possible participation in sport. Of course, the paediatric cardiologist must always decide on a case-by-case basis.
Precise knowledge of the underlying disease and previous interventions and treatment steps is essential for the assessment of physical performance and fitness for sport. The permission to exercise can of course change over time, depending on the current findings and haemodynamic conditions. In addition to the cardiac ultrasound, a long-term ECG, exercise ECG and an ergometric examination help us. The results of the exercise test indicate whether the corresponding performance requirements can be met by patients who have undergone heart surgery. Each type of sport places its own load on the heart. Static exercise leads to an increase in systolic, diastolic and mean blood pressure and to concentric hypertrophy of the left ventricle. During dynamic exercise, an increase in heart rate and stroke volume leads to volume hypertrophy of the left ventricle. An inappropriate load can cause considerable damage to the operated heart.
The operated heart needs to be closely monitored with regard to exercise tolerance. There are clear "general recommendations" for some heart operations, such as Fontan. Diving and all activities involving pressure should be avoided. In the case of severe aortic valve insufficiency, all contact sports should be avoided.
If an artificial heart valve is implanted, blood thinning is necessary. There is an increased risk of injury under anticoagulation. Patients with a pacemaker should also avoid certain sports with an increased risk of injury.
In the case of cardiac arrhythmia and the risk of presyncope and syncope, any sporting activity that puts others or yourself at risk is prohibited.
For most patients, an absolute ban on sport is not necessary.