{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,21]],"date-time":"2026-02-21T14:59:58Z","timestamp":1771685998696,"version":"3.50.1"},"reference-count":14,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2026,1,24]],"date-time":"2026-01-24T00:00:00Z","timestamp":1769212800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,2,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The surveillance of athletes with congenital heart disease remains challenging despite recent recommendations. Stress echocardiography as a diagnostic tool is not yet part of the routine follow-up but has emerged as an innovative approach to assess cardiac reserve and exercise capacity. It can unmask cardiac exercise pathophysiology and hence inform decision making for repeat interventions in athletes with complex congenital heart disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case summary<\/jats:title>\n                    <jats:p>This case report describes two athletes with Tetralogy of Fallot who, despite similar conditions, exhibit different cardiovascular risks. Their above average exercise capacity masks early cardiac deterioration, underscoring the limitations of cardiopulmonary exercise testing in assessing myocardial function. Stress echocardiography revealed severe biventricular dyssynchrony in one athlete, playing a major role in decision-making to perform a pulmonary valve replacement (PVR). Post transcatheter PVR, improved left ventricular\u2013right ventricular synchrony was seen at rest and during exercise stress echocardiography.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In athletes with congenital heart disease (CHD), disease worsening might be masked by above-normal exercise capacity, and detailed assessment, including cardiopulmonary exercise testing and exercise echocardiography, might be needed to detect underlying pathophysiology and hence guide the therapeutic approach. Two-strain during exercise echocardiography can be used to quantify cardiac function but also decipher interventricular dyssynchrony in CHD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytag045","type":"journal-article","created":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T12:54:30Z","timestamp":1769086470000},"source":"Crossref","is-referenced-by-count":0,"title":["Two young athletes with Tetralogy of Fallot\u2014stress echocardiography in therapeutic decision-making: a case report"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-6086-4456","authenticated-orcid":false,"given":"Melina","family":"Winkler","sequence":"first","affiliation":[{"name":"Department of Paediatrics and Adolescent Medicine, Division of Pediatric Cardiology, Medical University Graz , Auenbruggerplatz 34\/II, 8036 Graz 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City Street, Doha ,","place":["Qatar"]},{"name":"Institute of Sport, Exercise and Health, University College London , 170 Tottenham Court Road, London W1T 7HA ,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2026,1,24]]},"reference":[{"key":"2026022109014707200_ytag045-B1","doi-asserted-by":"crossref","first-page":"4191","DOI":"10.1093\/eurheartj\/ehaa501","article-title":"Recommendations for participation in competitive sport in adolescent and adult athletes with Congenital Heart Disease (CHD): position statement of the Sports Cardiology & Exercise Section of the European Association of Preventive Cardiology (EAPC), the European Society of Cardiology (ESC) Working Group on Adult Congenital Heart Disease and the Sports Cardiology, Physical Activity and Prevention Working Group of the Association for European Paediatric and Congenital Cardiology 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