The outstanding improvement in the survival of patients with congenital heart disease (CHD) has shifted our attention to long-term functional outcomes in this unique cohort. One of early observations made by physicians caring for these patients is that these patients commonly had impaired exercise capacity. Many factors might be responsible for this phenomenon, including residual cardiovascular defects, repeated surgical interventions, deconditioning, and even medication effects. Regardless of underlying mechanisms, exercise intolerance is perhaps the single most important determinant for impaired quality of life of these patients, even though patients’ self-perception of their exercise tolerance might unrealistically optimistic. Therefore, formal cardiopulmonary exercise testing (CPX) emerged as an essential and routine evaluation of CHD patients. It not only reliably and objectively assesses exercise capacity, but also provides valuable risk stratification data.
　　At 2011, the pediatric cardiology team of National Taiwan University Children’s Hospital established a CPX lab specialized for children and patients with CHD. The exercise testing was conducted mostly via a bicycle, with continuous monitoring of ECG, blood pressure, and oxygen saturation. Inspiratory and expiratory gas concentration was analyzed continuously throughout the exercise. It usually takes 30-40 minutes for one session of test. A comprehensive CPX could provide useful clinical information to physicians and patients, including individual exercise capacity (mostly evaluated by the percentage of predicted peak oxygen consumption), heart rate and blood pressure response to exercise, arrhythmic or ischemic evidence during exercise, and individual exercise prescription based on aforementioned data. Furthermore, linking to patients’ clinical data, a detailed analysis of various maximal and submaximal exercise parameters could possibly provide data on risk stratification and response to treatment. In this talk, I would like to briefly introduce the application of CPX in CHD, and share our experience of utilizing CPX in patient care and clinical research.