Role of the right-to-left interatrial shunt in exercise tolerance of patients with paucisymptomatic Ebstein's anomaly.

The aim of this study was to assess cardiorespiratory tolerance to exercise in children with non-operated, paucisymptomatic and untreated forms of Ebs tien's anomaly. The authors undertook a prospective study in 11 children, mean age 9.6 year s, who had lung function tests, cardiorespiratory exercise stress tests (bi cycle ergometry N=8, treadmill N=3) and contrast echocardiography. All parameters of spirometry were normal. Contrast echocardiography showed a right-to-left interatrial shunt in 7 children (group 1) whereas the remai ning 4 children had no shunt (group 2). The resting oxygen saturation was 9 7.4 +/- 2%, with no difference between the two groups. On the other hand, o xygen saturation at peak VO2 (VO2 max) was 90 +/- 9.5%, significantly lower in group 1 than in group 2 (85.7 +/- 2.2% vs 98.2 +/- 1.2%; p=0.03). In gr oup 1, the VO2 max was correlated to oxygen saturation (r=0.98; p< 0.001, N =6). The oxygen desaturation was correlated with presence of a right-to-lef t interatrial shunt (p=0.01). The reduced exercise tolerance of non-operated, paucisymptomatic children w ith Ebstein's anomaly is due to a right-to-left interatrial shunt. In patie nts with poor exercises tolerance, contrast echocardiography is advised for the detection of these atrial shunts.