Affiliation:
1. From Montreal Heart Institute (M.C.B., J.-F.B., A.D., M.J., P.D.G., L.-A.M.), Montreal, Quebec, Canada.
Abstract
Background—
Controversy exists as to whether secundum atrial septal defects (ASDs) in asymptomatic or mildly symptomatic New York Heart Association (NYHA) class I or II adult patients should be closed.
Methods and Results—
Thirty-seven patients (24 females; mean age 49.4 years, range 19 to 76) with a mean pulmonary to systemic flow ratio (Qp:Qs) of 2.1 (1.2 to 3.4) had a maximal oxygen uptake (V
o
2max
) determination and echocardiographic measurement of right ventricular dimensions before and 6 months after elective percutaneous closure of ASD. At baseline, mean V
o
2max
was 23.5±6.4 mL/kg per minute and was higher in the 15 NYHA I patients than in the 22 NYHA II patients (27±6.9 versus 20.8±4.6 mL/kg per minute;
P
=0.0015). V
o
2max
increased significantly at 6 months (23.5±6.4 to 26.9±6.9 mL/kg per minute;
P
<0.0001). Improvement was as marked in NYHA I (+22%;
P
<0.0001) as in NYHA II patients (+12%;
P
<0.0001), in patients with Qp:Qs 1.2 to 2.0 (+16%;
P
<0.0001) as in those with Qp:Qs >2 (+12%;
P
<0.0001), and in patients ≥40 years of age (+14%;
P
<0.0001) as in those <40 years of age (+16%;
P
<0.0001). Compared with 15 of 37 patients before closure, 35 of 37 patients were in NYHA I at 6 months. Right ventricular dimensions decreased significantly (
P
<0.0001).
Conclusions—
Adult ASD patients significantly increase their functional capacity after percutaneous defect closure. This is observed even in patients classified as asymptomatic, in those with lesser shunts, and in older patients. These findings suggest that ASD closure in an adult population should be considered even in the absence of symptoms.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Physiology (medical),Cardiology and Cardiovascular Medicine
Reference23 articles.
1. Moss AJ Adams FH. Heart Disease in Infants Children and Adolescents Including the Fetus and Young. 5th ed. Baltimore Md: Williams & Wilkins; 1995: 60–70 689–701.
2. Natural history of atrial septal defect.
3. Kirklin JW Barratt-Boyes BG. Cardiac Surgery. 2nd ed. New York NY: Churchill Livingstone Inc; 1993: 609–644.
4. Long-Term Outcome after Surgical Repair of Isolated Atrial Septal Defect
5. Comparison of the ramp versus standard exercise protocols
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