Please select the eligibility criteria that correspond to the clinical trial below.
Title: Cardiovascular, Pulmonary and Skeletal Muscle Evaluation in Patients With Univentricular Physiology in the Late Postoperative Period of the Fontan Surgery: Effects of Exercise Training
Brief Summary: Introduction: The Fontan operation is the surgical treatment in most patients with either anatomic or functional single ventricles. In this operation, the subpulmonary ventricle is bypassed, connecting the systemic veins directly to the pulmonary arteries. The lack of a subpulmonary ventricle is associated with a nonpulsatile pulmonary flow and triggers a sequence of adaptive mechanisms along the life of these patients. The most frequent consequence of these adaptative mechanisms is the reduction in functional capacity, objectively measured by the decrease in peak oxygen consumption (VO2). So, cardiovascular and pulmonary functioning and skeletal muscle alterations can explain exercise intolerance in these patients.

Objectives: 1. To compare the cardiovascular, pulmonary, and musculoskeletal system variables in clinically stable Fontan patients with Healthy subjects; 2. To correlate the variables of the cardiovascular, pulmonary, and skeletal muscle with the functional capacity in Fontan patients; 3. To identify predictors of low functional capacity in this population; 4. To evaluate four-month aerobic exercise and inspiratory muscle training on functional capacity, pulmonary function, and autonomic control in patients after Fontan operation and compare to the group with no exercise training.

Methods: All subjects were submitted to cardiovascular, pulmonary, and skeletal muscle evaluation at baseline to perform a cross-sectional study comparing Fontan Patients (FP) with Healthy Controls (HC). In addition, the FP accepted to participate in the longitudinal clinical trial to evaluate exercise programs were randomized into three groups: Aerobic Exercise Training (AET), Inspiratory Muscle Training (IMT), and Non-exercise Training Group (NET, a control group). All patient groups (AET, IMT, NET) were reassessed after four months of training or under usual care.

Expected Outcomes: This study expects to demonstrate that impaired pulmonary function, altered neurovascular control, and reduced skeletal muscle could be an additional potential mechanism for reducing functional capacity in clinically stable Fontan patients. And this impairment could be diminished by exercise training, enhancing physical capacity, and exercise tolerance.


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:

* being diagnosed with CHD by a pediatric cardiologist and qualifying as having simple or moderate CHD complexity according to the 2008 American College of Cardiology/American Heart Association guidelines;
* having a regular pulse;
* being 15-24 years of age;
* being conversant in Mandarin and Taiwanese;
* possessing a smartphone with Internet connection;
* agreeing to wear an exercise-monitoring wristband to record physiological data;
* agreeing to engage in exercises designed to test cardiopulmonary endurance;
* agreeing to participate in the study and sign an informed consent form for a relevant interview. For participants under 20 years of age, guardian approval by signing a written consent form was required.

Exclusion Criteria:

* having cognitive impairment to the extent of being noncommunicative;
* having CHD complicated with other congenital abnormalities;
* having undergone a cardiac catheter-related intervention or surgery within the past 6 months;
* being pregnant
C: Inclusion Criteria:

1. Between the ages of 18-25 (if 18, must no longer be in high school and no longer living at home)
2. Are diagnosed with moderate or complex structural congenital heart disease
3. Live within 120 miles of Nationwide Children's Hospital

Exclusion Criteria:

1. Do no speak or write proficiently in English
2. Have cognitive impairments that would interfere with the completion of study procedures
3. Are diagnosed with a genetic syndrome (e.g., Downs, Marfans)
4. Have been engaged in a formal exercise program within the past 6 months
5. Underwent open-heart surgery or have had a transcatheter valve replacement in the last 3 months
6. Are otherwise prohibited by their cardiologist to engage in at least moderate levels of physical activity
7. Are unable to complete a treadmill-based exercise stress test
8. Are currently pregnant
9. Have contraindications for exercise based on an exercise stress test (e.g., exercise-induced arrhythmias or evidence of cardiac ischemia)
10. \>150 min/weekday of moderate-to-vigorous physical activity per the accelerometer
11. Do not have access or a device for videoconferencing with the coach
D: Inclusion Criteria:

* Boys and girls ages 10 to 17 years with repaired Tetralogy of Fallot, currently followed at The Hospital for Sick Children, Toronto, Ontario
* Participant fluent in English

Exclusion Criteria:

* Moderate-to-severe ventricular dysfunction at the latest echocardiogram (defined as the qualitative grade given on the echocardiogram done closest to the intervention)
* Previous history of or documented frequent premature atrial or ventricular contractions or runs or associated tachycardia at the latest exercise test
* Reside outside 50km radius from SickKids or \>1hour travel distance to SickKids
* Lack of internet and computer/laptop access
* Skeletal muscle or orthopedic pathologies
* Neurodevelopmental delay that would preclude participation in an exercise program
* History of syncope with exercise
* Planned surgery requiring admission to intensive care unit during the study intervention

Answer: A