CONGRESS ABSTRACT

Exercise stress echocardiography (ESE) has proven to be a valuable diagnostic tool in various clinical settings, recently, evidence has shown that this technique can also be useful in evaluating patients with congenital heart disease (CHD). We present our personal experience with the use of this method in a cohort of patients with CHD. From December 2023 to December 2024, we performed ESE in 10 patients (pts) with CHD, 7 males. The mean age was 23 years with 3 pediatric pts. All patients had surgically corrected CHD: aortic coarctation; right ventricular outflow tract obstructive lesions; atrioventricular canal defect; transposition of the great arteries repaired with the Mustard procedure; and congenitally corrected transposition of the great arteries treated with a double switch. Half of the patients were on medical therapy. The indications for testing were: assessment of the hemodynamic profile or in the presence of mild to moderate abnormalities on instrumental evaluation , or in presence of nonspecific exertional symptoms with a hemodynamic burden not present or only mild at resTests were conducted on a semisupine cycle ergometer using an incremental protocol of 10 or 20 watts every two minutes. Echocardiographic assessments were carried out at baseline, at intermediate workload, at peak exercise, and at the first and fifth minute of recovery. Ventricular function was always evaluated and the behaviour of gradients in the presence of obstructive lesions were also assessed. All tests were pushed to volitional muscular exhaustion. The mean workload tolerated was 115 watts. Maximal heart rate exceeded 82% of the predicted value in 7 pts. There were no ECG changes and no arrhythmias. In 3 pts the test unmasked severe exercise‑induced hemodynamic burden. In the two pts with nonspecific exertional symptoms it was possible to identify the mechanism underlying the symptoms and accordingly adjust medical therapy. In the remaining pts, although exercise increased hemodynamic burden, it was not of a significant degree, and it was possible to provide guidance regarding the intensity of physical activity that could be safely performed. In conclusion, although numerically limited, our experience confirms that ESE plays a meaningful decision-making role, particularly in cases with ambiguous instrumental burden or symptoms. Another useful application is to provide guidance on the intensity of exercise that can be tolerated in the presence of residual anomalies.