PREOPERATIVE AND POSTOPERATIVE EXERCISE CAPACITY ASSOCIATED WITH HEMODYNAMICS IN ADULT PATIENTS WITH ATRIAL SEPTAL-DEFECT - A RETROSPECTIVESTUDY

Objective: This study evaluated the pre- and postoperative exercise ca pacity in adult patients with atrial septal defect (ASD) associated wi th hemodynamic variables. Methods: Adults (70) with ASD underwent symp tom-limited exercise tests. Peak O-2 uptake (Peak VO2) and % peak VO2, that is the percentage of predicted value, were measured. These patie nts were divided into three groups according to pulmonary-to-systemic flow ratio (Qp/Qs) and systolic pulmonary arterial pressure (PAs); Gro up A: Qp/Qs less than or equal to 3, PAs less than or equal to 50 mm H g, Group B: Qp/Qs > 3, any PAs, Group C: Qp/Qs less than or equal to 3 , PAs > 50 mm Ng. Exercise test was repeated in 22 patients after surg ical closure of ASD (mean 4.6 +/- 2.0 months). Results: Peak VO2 was s ignificantly lower in group B (P < 0.01) and group C (P < 0.01) than i n group A (19.3 +/- 5.7, 17.6 +/- 3.6, 27.6 +/- 6.3 ml/min/kg, respect ively). In patients except those in group C, there were a weak negativ e correlation between PAs and % peak VO2 (r = 0.61) and a significant negative correlation between Qp/Qs and % peak VO2 (r = 0.86). Postoper ative peak VO2 increased significantly in group A (27.2 +/- 5.1-31.1 /- 5.1 ml/min/kg, P < 0.05) and group B (16.7 +/- 3.3-21.5 +/- 2.1 ml/ min/kg, P < 0.01). However, there was no significant difference betwee n pre- and postoperative peak VO2 in group C (16.8 +/- 1.3-17.8 +/- 2. 8 ml/min/kg, NS). Conclusions: In ASD patients except those with small or moderate left-to-right shunt and high pulmonary arterial pressure, there was a significant negative correlation between Qp/Qs and peak V O2 corrected by age and gender. Patients with large left-to-right shun t and/or high pulmonary arterial pressure had reduced exercise capacit y. However, exercise capacity in patients with large left-to-right shu nt increased after closure of ASD regardless of whether they had high pulmonary arterial pressure. (C) 1997 Elsevier Science B.V.