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This doctoral research in Specialized Medical Sciences at the University of Bologna focuses on new applications of cardiopulmonary exercise testing and training in pediatric heart disease. The study explores exercise capacity in various congenital heart defects, including left-to-right shunts, systemic right ventricle, cyanotic congenital heart disease, univentricular physiology, and pediatric dilated cardiomyopathy. The research aims to investigate the effects of exercise training on patients with these conditions and to identify potential limitations and future perspectives for improving exercise tolerance. The study is based on a comprehensive review of existing literature and includes original research on exercise capacity in patients with Fontan circulation and other congenital heart defects. The results show that exercise capacity is reduced in patients with congenital heart defects, but exercise training can improve exercise tolerance and quality of life. The study highlights the importance of individualized exercise programs and the need for further research on the effects of exercise training on patients with congenital heart disease.