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CLINICAL RESEARCH: CONGENITAL HEART DISEASE

Determinants of cardiopulmonary functional improvement after transcatheter atrial septal defect closure in asymptomatic adults

Alessandro Giardini, MD^*,*, Andrea Donti, MD^*, Roberto Formigari, MD, FACC^*, Salvatore Specchia, MD, Daniela Prandstraller, MD^*, Gabriele Bronzetti, MD^*, Marco Bonvicini, MD^* and Fernando M. Picchio, MD^*

^* Pediatric Cardiology and Adult Congenital Unit, Bologna, Italy
Institute of Cardiology, University of Bologna, Bologna, Italy

Manuscript received August 4, 2003; revised manuscript received October 2, 2003, accepted October 7, 2003.

^* Reprint requests and correspondence: Dr. Alessandro Giardini, Pediatric Cardiology and Adult Congenital Unit, University of Bologna, Via Massarenti 9, Bologna, 40138 Italy.
alessandro5574{at}iol.it

OBJECTIVES: We sought to evaluate the course of cardiopulmonary function after transcatheter atrial septal defect (ASD) closure and to identify the physiopathologic mechanisms leading to this change.

BACKGROUND: Conflicting reports exist on cardiopulmonary functional improvement in asymptomatic adults after transcatheter closure of a secundum ASD.

METHODS: Thirty-two consecutive adults (13 males; age 42.6 ± 16.7 years) underwent maximal cardiopulmonary exercise testing and transthoracic echocardiography both on the day before and six months after transcatheter ASD closure. Mean pulmonary artery pressure, pulmonary to systemic flow ratio (Qp/Qs), and ASD diameter were measured before closure.

RESULTS: Peak oxygen uptake (VO₂) (p < 0.001), peak oxygen pulse (p = 0.0027), and vital capacity (p = 0.0086) improved after ASD closure, although peak heart rate did not. A significant correlation was found between peak VO₂ improvements and Qp/Qs (p = 0.0013). Left ventricular ejection fraction (LVEF) (p < 0.0001) and left ventricular end-diastolic diameter (LVEDD) (p < 0.0001) significantly increased after six months, although left ventricular end-systolic diameter did not. Right ventricular long- and short-axis dimensions decreased (both p < 0.0001). Peak VO₂ and of peak oxygen pulse improvements correlated to both LVEF (p = 0.0009 and 0.0019, respectively) and LVEDD (p < 0.0001 and 0.032, respectively) increments. The decrease of both long- and short-axis right ventricular dimensions positively correlated to both LVEF and LVEDD improvements. The improvement in LVEF correlated to Qp/Qs (p = 0.0026).

CONCLUSIONS: Transcatheter ASD closure leads to a significant improvement in cardiopulmonary function within six months, via an increase in peak oxygen pulse. An increase in both left ventricular stroke volume and cardiac output due to a positive ventricular interaction is the mechanism leading to improved peak VO₂.

Abbreviations and Acronyms   ASD = atrial septal defect   FEV1 = forced expiratory volume in 1 s   LV = left ventricle/ventricular   LVEDD = left ventricular end-diastolic diameter   LVEF = left ventricular ejection fraction   LVESD = left ventricular end-systolic diameter   NYHA = New York Heart Association   Qp/Qs = pulmonary to systemic flow ratio   RV = right ventricle/ventricular   TEE = transesophageal echocardiography   TTE = transthoracic echocardiography   VC = vital capacity   VO2 = oxygen uptake

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