الفهرس 
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Abstract
Congenital heart disease (CHD) is the most common birth defect, occurring in approximately 8 out of every 1,000 births; Many patients with CHD face unique psychosocial, educational, and behavioral challenges.
Health-related quality of life (HRQOL) is an important consideration for patients with CHD as routine clinical measurements, HRQOL assessments in CHD can provide validated measures of functional data that correlate with findings from standardized clinical assessment tools.
Pulmonary function is a dynamic, non-invasive assessment of the pulmonary system, to our knowledge, the objective of pulmonary function is to determine functional capacity in the individual. Spirometry is the most frequently used measure of pulmonary function provides a window on cardiac function.
An Electrocardiogram (ECG) stress test monitors the heart’s electrical activity during exercise with the exercise stress comes from walking on a treadmill. The echocardiography is performed so that any structural abnormalities in the wall of the heart can be assessed and to measure cardiac function.
This study aimed to assess degree of exercise intolerance in children with CHD operated or not, cyanotic or acyanotic and its impact on QOL using stress ECG and Pulmonary function testing. This cross-sectional study was conducted on 104 children and adolescents aged 8-18 years suffering from congenital heart diseases.
Summary of our results:
• In this study males were 51.9% of studied patients while females were 48.1%, about 34.6% of the studied children showed positive consanguinity. most of cases in our study were Double outlet right ventricle (DORV), Transposition of great artries (D TGA), coarcitation of aorta (CoA)and Ventricular septal defect (VSD), with percentage 27%, 26%, 22% and 20% respectively, Children with single congenital heart disease lesion were 58.7% and children with Cyanotic heart disease were 73.1% of the studied population; while 64% of the studied children were operated.
• About 30% of cases had systolic murmur on auscultation, pallor was in 22.1% while 20.2% experienced dyspnea, 13.5% tachypnea and Cyanosis was found in nearly 5% of the studied group. Most of patients (82.7%) had normal range blood gas analysis.
• In patients with CHD lesions, Weight and height percentiles were statistically lower in multiple CHD lesions and in non-operated groups than in children with single CHD lesions and in operated children, also there was a negative correlation between weight percentile and height percentile and delay time of operation.
• Regarding the impact of surgical interventions on children’s quality of life across various dimensions using the Kidscreen-52 questionnaire, a significant enhancement was observed in operated children, Specifically, in physical well-being and psychological well-being with a highly significant statistical difference. Significant improvements were also noted in self-perception, autonomy, moods and emotions.
• The differences in quality of life between children with cyanotic versus acyanotic congenital heart diseases. indicated that children with acyanotic conditions generally fared better in physical and psychological well-being. However, no significant differences were observed in moods and emotions, self-perception, and autonomy.
• The outcomes based on the number of cardiac lesions—single versus multiple. Children with a single cardiac lesion demonstrated superior outcomes in several items such as physical and psychological well-being, moods and emotions, self-perception, and the school environment, also there was a negative correlation between time of delay of operation and Kidscreen 52 questionnaire in the following items: Physical well-being, Psychological well-being, Moods and emotions, Self-perception, Autonomy ,Bullying, Parent relation and home life; while Financial resources, Peers and social support, School environment showed no correlation with time of delay of operation.
• Regarding pulmonary function, about 21.2% of the studied sample showed restrictive lung disease pattern while 19.2% showed obstructive lung disease pattern. There was statistically significant decrease in all parameters of pulmonary function test in operated children; FEV1, FVC, FEV1/FVC and MMEF compared to non-operated children. There was no statistically significant difference between cyanotic and non-cyanotic disease, children with multiple congenital heart lesions showed more restrictive pattern with statistically significant lower FVC than in single cardiac lesion.
• Regarding ECHO results showed that there were 40 children who showed variable degree of systolic dysfunction even with treatment and surgical interference. Results showed also that non-operated children had significantly lower EF% and FS%. Also, there was lower EF% and FS% in patients with multiple lesions.
• The studied group showed baseline ECG changes with RV hypertrophic changes was observed in 37.5% while Rt Axis deviation was in 39.4%. LV hypertrophic changes were observed in 12.5% while Lt Axis deviation was in 10.5%.
• Treadmill exercise was done noticing ECG changes and monitoring vital signs. ECG changes from baseline were recorded positive in 16 cases with 9 showing Arrythmia all were extrasystole while 7 showed ischemic changes. These changes were statistically observed in cyanotic, non-operated and multiple lesions than in non-cyanotic, non-operated and single lesion.
• There was a statistically significant increase in HR and decrease in SpO2 after exercise in all studied children, a statistically more significant increase in HR after exercise in acyanotic cardiac children, a statistically more significant increase in HR before and after exercise in non-operated and in children with multiple CHD lesions, while there was statistically significant decrease in SpO2 before and after exercise in children with cyanotic heart disease and a statistically significant decrease in SpO2 before and after exercise in non-operated and in children with multiple CHD lesions.