Late recovery of the cardiopulmonary exercise capacity after transcatheter amplatzer device closures for atrial septal defects in adults

Yoshiba, Shigeki; Kojima, Tetsuya; Oyanagi, Takayuki; Toda, Köichi; Osada, Yuji; Muraji, Shota; Imamura, Tomohiko; Nakano, Shintaro; Makita, Shigeru; Kobayashi, Toshiki; Sumitomo, Naokata

doi:10.1007/s00380-020-01741-7

Cited by 5 publications

(5 citation statements)

References 23 publications

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“…The larger left ventricular volumes after ASD closure did however not lead to an increased cardiac output, since heart rate decreased. These results are in line with other studies ( Teo et al, 2008 ; Yoshiba et al, 2021 ). The reason for lower left ventricular end-diastolic volume and stroke volume in patients with rToF compared to controls might be explained by reduced transpulmonary flow caused by the pulmonary regurgitation leading to low left ventricular filling ( Kopic et al, 2017 ; Ylitalo et al, 2018 ).…”

Section: Discussionsupporting

confidence: 94%

“…Peak VO 2 in patients with ASD did not change 12 months after ASD closure in contrast to what has been reported by other groups ( Yoshiba et al, 2021 ). This could be explained by peak VO 2 before intervention already being within the normal range of what was expected in contrast to earlier reports that have shown mildly impaired peak oxygen uptake in patients with ASD ( Kempny et al, 2012 ).…”

Section: Discussioncontrasting

confidence: 87%

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Patients with volume-loaded right ventricle - quantification of left ventricular hemodynamic response to intervention measured by noninvasive pressure-volume loops

Sjöberg,

Stephensen,

Arheden

et al. 2023

Front. Physiol.

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Volume loading of the right ventricle (RV) in patients with atrial septal defect (ASD) and patients with repaired Tetralogy of Fallot (rToF) affects the pumping mechanics of the left ventricle (LV). Intervention of the lesion will relieve the RV volume load however quantifiable impact on exercise capacity, arrhytmias or death are limited. A possible explanation could be remaining effects on the function of the LV. The aim of this study was therefore to investigate if hemodynamics of the LV differs between patients with RV volume load due to ASD or rToF and healthy controls and if they change after intervention. Eighteen patients with ASD, 17 patients with rToF and 16 healthy controls underwent cardiac magnetic resonance imaging (CMR) and maximal exercise test with continuous gas analysis. Reexamination was performed 13 ± 2 months after closure of the ASD in 13 of the patients and 10 ± 4 months after pulmonary valve replacement (PVR) in 9 of the patients with rToF. Non-invasive PV-loops from CMR and brachial pressures were analyzed. Stroke work (SW) and potential energy (PE) increased after ASD closure but not in ToF patients after valve repair. Patients with ASD or rToF had higher contractility and arterial elastance than controls. No major effects were seen in LV energetics or in peak VO2 after ASD closure or PVR. Peak VO2 correlated positively with SW and PE in patients with ASD (r = 0.54, p < 0.05; r = 0.61, p < 0.01) and controls (r = 0.72, p < 0.01; r = 0.53, p < 0.05) to approximately the same degree as peak VO2 and end-diastolic volume (EDV) or end-systolic volume (ESV). In ToF patients there was no correlation between PV loop parameters and peak VO2 even if correlation was found between peak VO2 and EDV or ESV. In conclusion, the LV seems to adapt its pumping according to anatomic circumstances without losing efficiency, however there are indications of persistent vascular dysfunction, expressed as high arterial elastance, which might have impact on exercise performance and prognosis. Future studies might elucidate if the duration of RV volume load and decreased LV filling have any impact on the ability of the vascular function to normalize after ASD closure or PVR.

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Section: Discussionsupporting

confidence: 94%

Section: Discussioncontrasting

confidence: 87%

Patients with volume-loaded right ventricle - quantification of left ventricular hemodynamic response to intervention measured by noninvasive pressure-volume loops

Sjöberg,

Stephensen,

Arheden

et al. 2023

Front. Physiol.

View full text Add to dashboard Cite

show abstract

“…Since there has been a growing interest in interventional procedures for PFO closure, we may wonder if it may be linked to improved exercise capacity in those patients. A study by Yoshiba et al [13] recruited 29 otherwise healthy asymptomatic or mildly symptomatic adult patients after a transcatheter ASD closure using an atrial septal occluder (ASO). They performed CPET and found that, although peak VO2 did not improve 3 months after the closure, a significant improvement was displayed 6 and 12 months after the intervention [13].…”

Section: Discussionmentioning

confidence: 99%

“…A study by Yoshiba et al [13] recruited 29 otherwise healthy asymptomatic or mildly symptomatic adult patients after a transcatheter ASD closure using an atrial septal occluder (ASO). They performed CPET and found that, although peak VO2 did not improve 3 months after the closure, a significant improvement was displayed 6 and 12 months after the intervention [13]. They further observed that the AT (anaerobic threshold) and VE/VCO2 slope did not significantly change 12 months after the ASD closure, suggesting that respiratory function in ASD patients may take longer to normalize after the closure or a certain degree of pulmonary hypertension may persist [13].…”

Section: Discussionmentioning

confidence: 99%

A sudden right-to-left shunt: the importance of evaluating patent foramen ovale during exercise

Crispino

Segreti²,

Porta³

et al. 2023

Monaldi Arch Chest Dis

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A 55-year-old male affected by heart failure with reduced ejection fraction and a history of a transient cerebrovascular accident was accepted to the Cardiology Department for worsening dyspnoea. A cardiopulmonary exercise testing was performed after therapy optimization to further evaluate exercise intolerance. A rapid increase in VE/VCO2 slope, PETO2, and RER, with a concomitant decrease in PETCO2 and SpO2, were observed during the test. These findings indicate exercise-induced pulmonary hypertension leading to a right-to-left shunt. Subsequent echocardiography with a bubble test unveiled the presence of an unknown patent foramen ovale. It is, therefore, necessary to exclude a right-to-left shunt by cardiopulmonary exercise testing, particularly in patients predisposed to develop pulmonary hypertension during exercise. Indeed, this eventuality might potentially provoke severe cardiovascular embolisms. However, the patent foramen ovale closure in patients with heart failure with reduced ejection fraction is still debated because of its potential hemodynamic worsening.

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“…Despite the observed suboptimal ventricular function in some patients, exercise capacity was normal in most patients with only 20% having a diminished VO2max. Previously, (near) normalization of exercise capacity in adults after ASD-closure has been described, enabling patients after ASD-closure to fully participate in sport activities [36,37].…”

Section: Ventricular Function and Exercise Capacitymentioning

confidence: 99%

Long term outcome after surgical ASD-closure at young age: Longitudinal follow-up up to 50 years after surgery

Kauling,

Pelosi,

Cuypers

et al. 2024

International Journal of Cardiology

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Late recovery of the cardiopulmonary exercise capacity after transcatheter amplatzer device closures for atrial septal defects in adults

Cited by 5 publications

References 23 publications

Patients with volume-loaded right ventricle - quantification of left ventricular hemodynamic response to intervention measured by noninvasive pressure-volume loops

Patients with volume-loaded right ventricle - quantification of left ventricular hemodynamic response to intervention measured by noninvasive pressure-volume loops

A sudden right-to-left shunt: the importance of evaluating patent foramen ovale during exercise

Long term outcome after surgical ASD-closure at young age: Longitudinal follow-up up to 50 years after surgery

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