{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T10:10:18Z","timestamp":1764843018338,"version":"build-2065373602"},"reference-count":54,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T00:00:00Z","timestamp":1756857600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background: Cardiopulmonary exercise testing (CPET) is increasingly recognized as a key tool for evaluating patients with congenital heart disease (CHD). While traditional assessments focus on resting parameters, CPET provides dynamic, integrated insight into cardiovascular, respiratory, and muscular function during exertion. Objectives: This review explores the clinical value of CPET across the spectrum of CHD, with dedicated focus on its applications in both adult and paediatric populations. We analyse the prognostic significance of key CPET parameters\u2014particularly peak oxygen consumption (peak VO2), ventilatory efficiency (VE\/VCO2 slope), and heart rate dynamics\u2014within distinct anatomical and physiological categories of CHD. Findings: CPET reliably detects exercise intolerance, guides intervention timing, informs exercise prescription, and stratifies risk. Peak VO2 and heart rate reserve are consistently associated with adverse outcomes across most CHD types. However, the prognostic utility of other variables, such as the VE\/VCO2 slope, varies with pathophysiology\u2014being less reliable in cyanotic lesions like Eisenmenger syndrome. In paediatric patients, CPET must be adapted to growth-related physiological variability and is increasingly used to assess quality of life, functional limitation, and response to therapy. Conclusions: CPET is a powerful, non-invasive tool that should be integrated into routine management of CHD patients across all ages. It enhances risk assessment, supports tailored care, and promotes safe physical activity, ultimately contributing to improved long-term outcomes and quality of life.<\/jats:p>","DOI":"10.3390\/children12091175","type":"journal-article","created":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T12:07:32Z","timestamp":1756901252000},"page":"1175","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Cardiopulmonary Exercise Testing in Congenital Heart Disease: A Never-Ending Story from Paediatrics to Adult Life"],"prefix":"10.3390","volume":"12","author":[{"given":"Giulia","family":"Guglielmi","sequence":"first","affiliation":[{"name":"Pediatric and Adult Congenital Heart Centre, IRCCS-Policlinico San Donato, Piazza Edmondo Malan, 2, 20097 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara","family":"Moscatelli","sequence":"additional","affiliation":[{"name":"Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London WC1N 3JH, UK"},{"name":"Centre for Paediatric Inherited and Rare Cardiovascular Disease, Institute of Cardiovascular Science, University College London, Gower Street, London WC1E 6BT, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giorgia","family":"Rocchetti","sequence":"additional","affiliation":[{"name":"Heart Failure Unit, Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy"},{"name":"Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, 20138 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Piergiuseppe","family":"Agostoni","sequence":"additional","affiliation":[{"name":"Heart Failure Unit, Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy"},{"name":"Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, 20138 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Massimo","family":"Chessa","sequence":"additional","affiliation":[{"name":"Pediatric and Adult Congenital Heart Centre, IRCCS-Policlinico San Donato, Piazza Edmondo Malan, 2, 20097 Milan, Italy"},{"name":"Department of Cardiovascular Diseases, Vita Salute San Raffaele University, Via Olgettina, 58, 20132 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9985-7407","authenticated-orcid":false,"given":"Massimo","family":"Mapelli","sequence":"additional","affiliation":[{"name":"Heart Failure Unit, Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy"},{"name":"Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, 20138 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1016\/j.ccl.2006.08.002","article-title":"Exercise intolerance in adults with congenital heart disease","volume":"24","author":"Dimopoulos","year":"2006","journal-title":"Cardiol. 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