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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Worldwide&#44; there are now more adults affected with congenital heart disease &#40;CHD&#41; than children&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Surgical advances and improvements in diagnosis and medical care have reduced early mortality and most patients now reach adulthood&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> The increasing longevity of this population has led to concerns about their well-being and quality of life&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Long-term complications are common&#44; with heart failure becoming a significant cause of exercise intolerance&#44; morbidity and mortality&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Assessment of CHD patients&#8217; functional state is important for prognostic reasons and&#44; as expected&#44; individuals with CHD have lower functional capacity than their peers&#44; even including patients who have undergone corrective surgery&#46; However&#44; such assessments should be treated with caution&#44; as they may underestimate the degree of limitation in adult patients with long-standing disease who have adapted their lifestyle to their ability&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Cardiopulmonary exercise testing &#40;CPET&#41; is an accurate tool for quantifying exercise capacity and can be used to assess abnormal cardiovascular response to increased pressure or volume demands&#46; However&#44; the ideal tool for risk stratification would provide early signs of insidious subclinical heart failure&#44; when the progressive disease is still reversible&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In this issue of the <span class="elsevierStyleItalic">Journal</span>&#44; Rosa et al&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> review the role of CPET as a potential tool for risk stratification&#44; aiming to identify adults with different types of CHD and impaired cardiovascular function&#46; Patients with left and right pressure or volume overload were selected&#46; The aim of the study was to assess and compare functional capacity in the different patient groups and to investigate a possible association between CPET parameters and outcome&#46; There were significant differences in CPET parameters between the study groups&#46; Cyanosis and pulmonary hypertension conferred poor exercise tolerance and an increased risk of hospitalization and mortality&#46; The progressive failure of a systemic right ventricle has deleterious effects on short- and long-term outcomes for all patients&#46; The right ventricle&#44; with its complex geometry and varied adaptive mechanisms in CHD when in the systemic position&#44; must by itself sustain the systemic load&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> This is the physiology of transposition of the great arteries with previous atrial switch repair&#44; mostly seen in older patients&#44; or congenitally corrected transposition of the great arteries&#44; operated or native&#44; double-inlet right ventricle and hypoplastic left heart syndrome&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The outcome of patients with CHD has improved in recent years due to advances in early diagnosis and treatment&#44; particularly cardiac surgery and intensive care procedures&#46; Earlier interventions may reverse ventricular remodeling and improve long-term benefits&#46; CPET has diagnostic and prognostic value in CHD&#46; However&#44; before randomized trials can be designed&#44; further research is necessary&#46; More routine use will play an important role in improving risk stratification of adults with CHD&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare&#46;</p></span></span>"
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