ATRIAL SEPTAL-DEFECT IN ADULTS - CARDIOPULMONARY EXERCISE CAPACITY BEFORE AND 4 MONTHS AND 10 YEARS AFTER DEFECT CLOSURE

Objectives. The purpose of the study was to evaluate the cardiopulmona ry exercise capacity and ventilatory function in adults with atrial se ptal defect (ASD) preoperatively and 4 months and 10 years postoperati vely. Background. Only few data are available on cardiopulmonary exerc ise tolerance after ASD closure, but detailed knowledge might be helpf ul for indication for defect closure in certain patients. Methods. The study was performed in adult patients (mean [+/-SD] age at operation 39.9 +/- 11.5 years; left-right shunt 9.6 +/- 5.6 liters/min; pulmonar y/systemic flow ratio 2.8 +/- 1.2; mean pulmonary artery pressure 18.2 +/- 6.2 mm Hg). Cardiopulmonary exercise testing was performed with a bicycle ergometer. We determined peak oxygen uptake, anaerobic thresh old, performance at anaerobic threshold and maximal performance in rel ation to these variables in a normal group. Ventilatory function at re st was expressed by vital capacity, maximal voluntary ventilation and forced expiratory volume in 1 s. Results. Preoperatively, ventilatory function at rest was only moderately reduced to similar to 75% to 85%. Four months postoperatively we found no significant improvement, but 10 years postoperatively ventilatory function at rest was normalized. Preoperative cardiopulmonary exercise capacity was markedly reduced to 50% to 60%; early postoperatively it was only slightly higher, but la te postoperatively exercise capacity significantly improved and was co mpletely normalized. Conclusions. Although preoperative cardiopulmonar y capacity in adult patients with nonrestrictive ASD was significantly decreased, some improvement was seen at 4 months postoperatively, wit h complete restitution to normal at 10 years after shunt closure. (C) 1997 by the American College of Cardiology.