Improvement in Exercise Capacity in Asymptomatic and Mildly Symptomatic Adults After Atrial Septal Defect Percutaneous Closure

• Published in: Circulation (New York, N.Y.) Vol. 106; no. 14; pp. 1821 - 1826
• Main Authors: Brochu, Marie-Claude, Baril, Jean-François, Dore, Annie, Juneau, Martin, De Guise, Pierre, Mercier, Lise-Andrée
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01.10.2002; American Heart Association, Inc
• Subjects: Adult; Age Factors; Aged; Biological and medical sciences; Blood Pressure; Cardiac Surgical Procedures - adverse effects; Cardiology. Vascular system; Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava; Echocardiography, Transesophageal; Exercise Tolerance; Female; Follow-Up Studies; Heart; Heart Function Tests; Heart Septal Defects, Atrial - classification; Heart Septal Defects, Atrial - physiopathology; Heart Septal Defects, Atrial - surgery; Hemodynamics; Humans; Male; Medical sciences; Middle Aged; Minimally Invasive Surgical Procedures - adverse effects; Oxygen Consumption; Pulmonary Artery - physiology; Respiratory Function Tests; Severity of Illness Index; Treatment Outcome; Tricuspid Valve Insufficiency - etiology; Human; Maximum oxygen consumption; Prognosis; Instrumentation therapy; Cardiovascular disease; Intracardiac defect; Instrumental obliteration; Congenital disease; Percutaneous route; Physical fitness; Treatment; Malformation; Follow up study; Heart disease; Atrial septal defect; Adult; Exercise tolerance test
• ISSN: 0009-7322; 1524-4539; 1524-4539
• DOI: 10.1161/01.CIR.0000029924.90823.E0

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.