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Cardiopulmonary exercise parameters in children with atrial septal defect and increased pulmonary blood flow:
J P Pfammatter1, M Zanolari, A Schibler
1Pediatric Cardiology, University Children's Hospital, Berne, Switzerland. jean.pierre.pfammatter@insel.ch
Insights
Children with atrial septal defects (ASD) show impaired exercise capacity and increased airway resistance at peak exercise. Shunt closure did not fully restore maximum oxygen uptake or chronotropic response, indicating persistent cardiorespiratory effects.
Area of Science:
- Pediatric Cardiology
- Cardiopulmonary Physiology
Background:
- Atrial septal defects (ASD) cause increased pulmonary blood flow, potentially impairing cardiopulmonary function during exercise.
- Limited data exist on the short-term effects of ASD closure on cardiorespiratory function at peak exercise in children.
Purpose of the Study:
- To prospectively evaluate preoperative and postoperative cardiorespiratory function at peak exercise in children with ASD.
- To compare these parameters with a matched healthy population.
Main Methods:
- Prospective study involving pulmonary function testing and cardiopulmonary exercise testing.
- Hemodynamic assessment preoperatively and 3-4 months postoperatively in 16 children with ASD.
- Comparison with 15 age-matched healthy children.
Main Results:
- Preoperatively, ASD patients showed no significant differences in baseline pulmonary function or exercise capacity compared to controls.
- At peak exercise, ASD patients exhibited increased pulmonary resistance, particularly in distal airways, and elevated serum lactate.
- Maximum oxygen uptake and chronotropic response to exercise were impaired in ASD patients, persisting postoperatively.
Conclusions:
- Cardiopulmonary exercise parameters in children with ASD showed only slight deviations from normal children.
- Key differences included reduced maximum oxygen uptake and increased airway resistance during maximal exercise.
- These findings highlight persistent cardiorespiratory limitations even after shunt closure.
Unlabelled:
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.