Please select the eligibility criteria that correspond to the clinical trial below.
Title: Impact of a Structural Phonation Training on Respiratory Muscle Function in Patients With Structural Heart Disease - HeartChoir
Brief Summary: Most patients with complex congenital heart disease and cardiomyopathy from acquired heart disease have reduced exercise capacity. Exercise capacity is associated with respiratory muscle strength and function. If structured respiratory muscle training positively influences respiratory muscle function in patients with structural heart disease is not well known. The aim of this study is to investigate whether regular singing lessons and breathing exercises improve respiratory muscle strength in patients with congenital or acquired structural heart disease.


Options:
A: Inclusion Criteria:

* Both gender, aged between 12 and 30 years
* Patients undergoing the Fontan operation with time postoperatively ≥5 years
* Clinically stable patients, no arrhythmia in the last electrocardiogram or clinical assessment
* Consent by the cardiologist
* Patients who voluntarily signed the consent form.

Exclusion Criteria:

* Patients with hypoplastic left heart syndrome
* Changes that reduce musculoskeletal walking skills
* Neurological sequelae, patients with associated genetic syndrome, disturbance cognitive or psychiatric
* Patients with a history of ventricular arrhythmias, cardio respiratory arrest, users of anti-arrhythmic drugs and / or underwent implantation of pacemaker
* Atrial arrhythmia requiring treatment in the last 6 months
* Patients with heart failure not controlled by medications and lung hypertension
* Patients with protein-losing enteropathy
* Severe hypoxemia (oxygen saturation \<80% at rest)
* Symptomatic patients with a diagnosis of diaphragmatic paresis or paralysis postoperative patients, with or without plication
* Patients with moderate to severe asthma
* Patients who live outside the area of Sao Paulo
B: Inclusion Criteria:

* Informed Consent as documented by signature (Appendix Informed Consent Form)
* age ≥ 18 years
* known cardiomyopathy from acquired heart disease (ischemic or dilated) or patients with complex CHD (cyanotic congenital heart disease, Fontan palliation, subaortic right ventricle or repaired tetralogy of Fallot)

Exclusion Criteria:

* Acute coronary syndrome, cardiac surgery or heart failure hospitalization within the previous 6 months
* chronic metabolic, orthopedic, or infectious disease; treatment with steroids, hormones, or cancer chemotherapy
* severe exercise-induced asthma
* professional singer or professionally performing a wind instrument
* Known or suspected non-compliance, drug or alcohol abuse
* Inability to follow the procedures of the study, e.g. due to language problems, psychological disorders, dementia, etc. of the participant,
C: Inclusion Criteria:

* Complex congenital heart disease ( e.g. tetralogy of Fallot, transposition of the great arteries, pulmonary atresia, patients palliated with Fontan procedure or total cavo-pulmonary connection).
* Clinically stable without significant change the last 3 months.
* Adult (\> 18 years of age).
* Informed consent.

Exclusion Criteria:

* Cognitive impairment affecting the ability of independent decision making.
* Present strategy of regularly executing resistance training \> 2times per week in purpose to increase muscle strength.
* Other comorbidity affecting physical activity.
* Other circumstance making participation unsuitable.
D: Inclusion Criteria:

* Congenital heart disease with allowance for unrestricted exercise
* Diagnosis: Q20.0 Truncus arteriosus communis, Q20.1 Transpositio vasorum incompleta, Q20.3 Transpositio vasorum completa, Q20.5 Inversio ventriculorum cordis, Q21.2 Defectus septi atrioventriculorum cordis, Q21.3 Tetralogia Steno-Fallot, Q22.4 Tricusspidalatresia , Q22.5 Anomalia Ebstein, Q23.2 Mitralatresia, Double outlet right ventricle, Q23.3 Hypoplasia ventriculi sinistri cordis syndrome, Q23.3 Hypoplasia ventriculi dextrii cordis syndrome, Q24.4 Stenosis subaortae congenita, Q25.1 Coarctatio aortae, Q25.1 Coarctatio Aortae, Double inlet left ventricle, Q25.3 Stenosis aortae supravalvularis, Q25.5 Pulmonalatresia.
* Successful Total Cavo Pulmonal Connex (TCPC procedure)
* 13- 16 years of age

Exclusion Criteria:

* Mental retardation
* Untreated asthma
* Syndromes related to CHD

Answer: B