Cardiopulmonary exercise parameters in children with atrial septal defect and increased pulmonary blood flow: short‐term effects of defect closure

Abstract

Markedly increased pulmonary blood flow because of a relevant atrial septal defect (ASD) leads to impaired cardiopulmonary function during maximum exercise in adults. No comparative preoperative and postoperative data are available on the short‐term effects of shunt closure on cardiorespiratory function at peak exercise in children. Pulmonary function testing at rest and cardiopulmonary exercise testing together with haemodynamic assessment was done prospectively in children with an ASD preoperatively and again after full recovery at 3–4 mo postoperatively and compared with a matched normal population. Sixteen children, aged 6.8–16.1 y, with a defect of 8–23 mm (median 15 mm) and a pulmonary/systemic flow ratio of 1.5–3.5 (median 2.2) were tested and compared with 15 healthy children. Preoperatively, baseline pulmonary function parameters and exercise capacity were no different from normals. At peak exercise, patients with a shunt had increased pulmonary resistance, especially of the distal airways (p= 0.04), with a significantly larger proportion of children having a paradoxical increase in total airway resistance during exercise (p < 0.05). Maximum serum lactate at peak exercise was elevated (p < 0.05) in patients. In patients, maximum oxygen uptake was impaired (p= 0.03) and remained so at repeat evaluation postoperatively. The same observation was made for chronotropic response to exercise. Conclusion: Cardiopulmonary exercise parameters in patients with ASD differed only slightly from those in normal children. The most important deviations were a lower maximum oxygen uptake and an increase in airway resistance at maximum exercise.

Atrial septal defect and exercise capacity: value of cardio-pulmonary exercise test in assessment and follow-up

“…Although exercise capacity seems to insidiously decrease with age, serial CPET studies starting from paediatric age are clearly missing (24). In a small paediatric cohort (N=16), CPET parameters in children with ASD only slightly differ from those in normal children (71). Another small cohort (N=10) found no differences in terms of VO 2max between children with ASD and controls (72).…”

Transcatheter closure of atrial septal defect in adults: time-course of atrial and ventricular remodeling and effects on exercise capacity

“…Several studies have reported the short- and long-term effects of ASD closure on patients and many of them demonstrate improved cardiopulmonary function [8–12], even in patients with a relatively small shunt ratio [13]. However, other studies have either shown no improvement in exercise capacity following defect closure [14, 15] or impaired exercise response compared to healthy controls [16, 17]. Therefore, better understanding of which patients will benefit from closure of ASD is of value.…”

Cardiopulmonary functional capacity in Taiwanese children with atrial septal defects

“…12,24 In our study, significantly diminished exercise capacity as indicated by lower peak VO 2 assessed by graded symptom-limited exercise testing was found in ASD children, either in surgically closed, transcatheter closure, or unrepaired status. In previous studies, ASD patients have impaired exercise capacity and declined peak VO 2 that is often at 50% to 60% of predicted values in healthy controls 12,[25][26][27] ; even in asymptomatic patients having minor reduction in peak oxygen consumption. 28 Besides, other CPET parameters including VE/VCO 2 slope, MET or VO 2 at AT, RER, pulse oximetry, VE/VO 2 , and VE/CO 2 are considered abnormal among ASD patients.…”