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The Ross procedure, where a pulmonary autograft (neoaorta) replaces the aortic valve, has excellent long-term outcomes in patients with congenital aortic valve disease. However, there are reports of neoaortic dilatation and dissection. An increasing number of women are wishing to become pregnant following the Ross procedure, but little is known about the occurrence and risks of neoaortic dilatation and complications in pregnancy. We investigated neoaorta function and outcomes in pregnancy following the Ross procedure.This retrospective study investigated women post-Ross procedure at a tertiary ACHD unit between 1997 and 2021. Imaging evaluated neoaortic root dimensions and regurgitation pre-, and post- pregnancy, compared with matched non-pregnant controls. Primary endpoints were change in neoaortic dimensions, degree of regurgitation and adverse maternal outcomes.Nineteen pregnancies in 12 women were included. The mean change in neoaortic root diameter post-pregnancy was 1.8 mm (SD 3.4) (p = 0.017). There was no significant change in neoaortic dimensions in matched controls during follow-up. There were no cases of dissection, arrhythmia, acute coronary syndrome, or maternal mortality. Three deliveries were pre-term, including one emergency Caesarean section due to maternal cardiac decompensation, requiring aortic root replacement post-partum but there were no neonatal deaths.Pregnancy following the Ross procedure is associated with neoaortic dilatation, and pregnancy is generally well tolerated. Although adverse maternal outcomes are uncommon, there are still rare cases of cardiac complications in and around the time of pregnancy. These findings emphasise the need for accessible pre-pregnancy counselling, risk stratification and careful surveillance through pregnancy by specialist cardio-obstetric multi-disciplinary teams.

Introduction:Regular physical activity is safe and effective therapy for adults with CHD and is recommended by European Society of Cardiology guidelines. The COVID-19 pandemic poses enormous challenges to healthcare teams and patients when ensuring guideline compliance. We explored the implications of COVID-19 on physical activity levels in adult CHD patients.Materials and methods:A data-based questionnaire was distributed to adult CHD patients at a regional tertiary centre from October to November 2020.Results:Prior to the COVID-19 pandemic, 96 (79.3%) of 125 respondents reported participating in regular physical activity, with 66 (52.8%) meeting target levels (moderate physical activity for at least 150 minutes per week). Commonest motivations for physical activity were general fitness (53.6%), weight loss (36.0%), and mental health benefits (30.4%). During the pandemic, the proportion that met target levels significantly decreased from 52.8% to 40.8% (p = 0.03). The commonest reason was fear of COVID-19 (28.0%), followed by loss of motivation (23.2%) and gym/fitness centre closure (15.2%).Discussion:The COVID-19 pandemic has negatively impacted exercise levels of adult CHD patients. Most do not meet recommended physical activity levels, mainly attributable to fear of COVID-19. Even before the pandemic, only half of respondents met physical activity guidelines. Availability of online classes can positively impact exercise levels so could enhance guideline compliance. This insight into health perceptions and behaviours of adult CHD patients may help develop quality improvement initiatives to improve physical activity levels in this population.

Introduction Exercise is a safe and effective therapy for adults with congenital heart disease (ACHD) with positive effects on morbidity, mortality and quality of life.1 European Society of Cardiology (ESC) guidelines recommend that exercise interventions and promotion of physical activity should occur at every contact between ACHD patients and healthcare professionals.2 We sought to investigate how many ACHD patients recall these interventions. Methods We designed and conducted a data-based prospective survey exploring exercise behaviors of ACHD patients and recall of discussions around physical activity. The questionnaire was distributed to patients in outpatient clinics and inpatient wards at a tertiary ACHD centre in the UK, between October and November 2020. Results In total 125 patients completed the survey. Demographically, 60% were women, 34% were men and 4% preferred not to answer. The majority of respondents were of White British or European ethnicity (73.6%). With regard to baseline physical activity levels, only 66 (52.8%) respondents met recommended exercise targets, participating in moderate physical activity for at least 150 minutes per week. This reduced further to 40.8% following the COVID-19 pandemic lockdown (p=0.03) (figure 1). Common motivations for physical activity were general fitness (53.6%), weight loss (36.0%) and mental health benefits (30.4%). Key reasons for reduced physical activity as a result of the pandemic were fear of COVID-19 (28.0%), loss of motivation (23.2%) and gym/fitness centre closure (15.2%) (figure 2). Almost two thirds (65.6%) of respondents did not recall having a discussion about exercise participation with healthcare professionals. Discussions about individualized exercise prescriptions were recalled by 8 respondents (6.4%). In total, 16% recalled being told to avoid certain exercises by their healthcare team; common responses of exercises to be avoided included high impact/contact sport and heavy weightlifting, with others told not to run, scuba dive or play golf. Conclusions Almost half of the surveyed population did not meet recommended exercise targets before the pandemic, with even fewer meeting recommendations during the first COVID-19 pandemic lockdown. The majority of patients do not recall ever having discussions about exercise with their healthcare team. Whilst we are unable to determine whether this is due to discussions not occurring or poor patient recall, there are clear deficiencies in the provision and/or retention of health promotional information surrounding exercise. Quality improvement initiatives to improve patient awareness and involvement in physical activity may be considered two-fold. Firstly, attention should be paid to improving patient recall of advice from consultations, which could involve the provision of written aids and individualised exercise prescriptions. Secondly, healthcare professional confidence in providing exercise recommendations to the heterogenous ACHD population is an area for improvement. This may include raising awareness of common motivations for exercise in this group that could be harnessed and formal education on available guidelines. The COVID-19 pandemic has negatively impacted exercise habits in the ACHD population and despite changes in healthcare service delivery, including the shift towards tele-medicine, the benefits of exercise must be emphasized at every opportunity. Conflict of Interest None References Dean PN, Gillespie CW, Greene et al. Sports participation and quality of life in adolescents and young adults with congenital heart disease. Congenit Heart Dis 2015;10:169–79. Pelliccia A, Sharma S, Gati S, et al. 2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease: The Task Force on sports cardiology and exercise in patients with cardiovascular disease of the European Society of Cardiology (ESC). European Heart Journal 2021;42(1):17–96.