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Right ventricular pressure response to exercise in adults with isolated ventricular septal defect closed in early childhood

  • Thomas Moller (a1), Harald Lindberg (a2) (a3), May Brit Lund (a2) (a4), Henrik Holmstrom (a1) (a2), Gaute Dohlen (a1) and Erik Thaulow (a1) (a2)...
Abstract

We previously demonstrated an abnormally high right ventricular systolic pressure response to exercise in 50% of adolescents operated on for isolated ventricular septal defect. The present study investigated the prevalence of abnormal right ventricular systolic pressure response in 20 adult (age 30–45 years) patients who underwent surgery for early ventricular septal defect closure and its association with impaired ventricular function, pulmonary function, or exercise capacity. The patients underwent cardiopulmonary tests, including exercise stress echocardiography. Five of 19 patients (26%) presented an abnormal right ventricular systolic pressure response to exercise ⩾ 52 mmHg. Right ventricular systolic function was mixed, with normal tricuspid annular plane systolic excursion and fractional area change, but abnormal tricuspid annular systolic motion velocity (median 6.7 cm/second) and isovolumetric acceleration (median 0.8 m/second2). Left ventricular systolic and diastolic function was normal at rest as measured by the peak systolic velocity of the lateral wall and isovolumic acceleration, early diastolic velocity, and ratio of early diastolic flow to tissue velocity, except for ejection fraction (median 53%). The myocardial performance index was abnormal for both the left and right ventricle. Peak oxygen uptake was normal (mean z score −0.4, 95% CI −2.8–0.3). There was no association between an abnormal right ventricular systolic pressure response during exercise and right or left ventricular function, pulmonary function, or exercise capacity. Abnormal right ventricular pressure response is not more frequent in adult patients compared with adolescents. This does not support the theory of progressive pulmonary vascular disease following closure of left-to-right shunts.

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Corresponding author
Author for correspondence: T. Möller, MD, PhD, Department of Paediatric Cardiology, Division of Paediatric and Adolescent Medicine, Oslo University Hospital – Rikshospitalet, P.O. Box 4950 Nydalen, 0424 Oslo, Norway. Tel: +47 90149702; Fax: +47 23072330; E-mail: thomas.moller@ous-hf.no; thofmol@gmail.com
References
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1. Marelli, AJ, Mackie, AS, Ionescu-Ittu, R, Rahme, E, Pilote, L. Congenital heart disease in the general population: changing prevalence and age distribution. Circulation 2007; 115: 163172.
2. Gersony, WM. Natural history and decision-making in patients with ventricular septal defect. Prog Pediatr Cardiol 2001; 14: 125132.
3. Duffels, MG, Engelfriet, PM, Berger, RM, et al. Pulmonary arterial hypertension in congenital heart disease: an epidemiologic perspective from a Dutch registry. Int J Cardiol 2007; 120: 198204.
4. Engelfriet, PM, Duffels, MG, Moller, T, et al. Pulmonary arterial hypertension in adults born with a heart septal defect: the Euro Heart Survey on adult congenital heart disease. Heart 2007; 93: 682687.
5. Roos-Hesselink, JW, Meijboom, FJ, Spitaels, SE, et al. Outcome of patients after surgical closure of ventricular septal defect at young age: longitudinal follow-up of 22-34 years. Eur Heart J 2004; 25: 10571062.
6. Moller, T, Brun, H, Fredriksen, PM, et al. Right ventricular systolic pressure response during exercise in adolescents born with atrial or ventricular septal defect. Am J Cardiol 2010; 105: 16101616.
7. Svennevig, JL, Bech, J, Karlsen, H, Amlie, E, Olsen, A. [From a registry to a clinical information system. Development of the Datacor system at the surgery department A, Rikshospitalet]. Tidsskr Nor Laegeforen 1995; 115: 10571059.
8. Lang, RM, Bierig, M, Devereux, RB, et al. Recommendations for chamber quantification. Eur J Echocardiogr 2006; 7: 79108.
9. Roche, SL, Vogel, M, Pitkanen, O, et al. Isovolumic acceleration at rest and during exercise in children normal values for the left ventricle and first noninvasive demonstration of exercise-induced force-frequency relationships. J Am Coll Cardiol 2011; 57: 11001107.
10. Ruan, Q, Nagueh, SF. Effect of age on left ventricular systolic function in humans: a study of systolic isovolumic acceleration rate. Exp Physiol 2005; 90: 527534.
11. De Sutter, J, De Backer, J, Van de Veire, N, Velghe, A, De Buyzere, M, Gillebert, TC. Effects of age, gender, and left ventricular mass on septal mitral annulus velocity (E’) and the ratio of transmitral early peak velocity to E’ (E/E’). Am J Cardiol 2005; 95: 10201023.
12. Nagueh, SF, Appleton, CP, Gillebert, TC, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. Eur J Echocardiogr 2009; 10: 165193.
13. Kaul, S, Tei, C, Hopkins, JM, Shah, PM. Assessment of right ventricular function using two-dimensional echocardiography. Am Heart J 1984; 107: 526531.
14. Rudski, LG, Lai, WW, Afilalo, J, et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr 2010; 23: 685713; quiz 786–688.
15. Pellett, AA, Tolar, WG, Merwin, DG, Kerut, EK. The Tei index: methodology and disease state values. Echocardiography 2004; 21: 669672.
16. Tei, C, Ling, LH, Hodge, DO, et al. New index of combined systolic and diastolic myocardial performance: a simple and reproducible measure of cardiac function--a study in normals and dilated cardiomyopathy. J Cardiol 1995; 26: 357366.
17. Kircher, BJ, Himelman, RB, Schiller, NB. Noninvasive estimation of right atrial pressure from the inspiratory collapse of the inferior vena cava. Am J Cardiol 1990; 66: 493496.
18. Fredriksen, PM, Ingjer, F, Nystad, W, Thaulow, E. Aerobic endurance testing of children and adolescents--a comparison of two treadmill-protocols. Scand J Med Sci Sports 1998; 8: 203207.
19. Fredriksen, PM, Ingjer, F, Thaulow, E. [A protocol for testing aerobic capacity in children and adolescents with congenital heart defects]. TidsskrNor Laegeforen 1998; 118: 26362639.
20. Edvardsen, E, Scient, C, Hansen, BH, Holme, IM, Dyrstad, SM, Anderssen, SA. Reference values for cardiorespiratory response and fitness on the treadmill in a 20- to 85-year-old population. Chest 2013; 144: 241248.
21. Paridon, SM, Alpert, BS, Boas, SR, et al. Clinical stress testing in the pediatric age group: a statement from the American Heart Association Council on Cardiovascular Disease in the Young, Committee on Atherosclerosis, Hypertension, and Obesity in Youth. Circulation 2006; 113: 19051920.
22. Moller, T, Peersen, K, Pettersen, E, Thaulow, E, Holmstrom, H, Fredriksen, PM. Non-invasive measurement of the response of right ventricular pressure to exercise, and its relation to aerobic capacity. Cardiol Young 2009; 19: 465473.
23. Yock, PG, Popp, RL. Noninvasive estimation of right ventricular systolic pressure by Doppler ultrasound in patients with tricuspid regurgitation. Circulation 1984; 70: 657662.
24. Grunig, E, Weissmann, S, Ehlken, N, et al. Stress Doppler echocardiography in relatives of patients with idiopathic and familial pulmonary arterial hypertension: results of a multicenter European analysis of pulmonary artery pressure response to exercise and hypoxia. Circulation 2009; 119: 17471757.
25. Quanjer, PH, Tammeling, GJ, Cotes, JE, Pedersen, OF, Peslin, R, Yernault, JC. Lung volumes and forced ventilatory flows. Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society. Eur Respir J Suppl 1993; 16: 540.
26. Chahal, NS, Lim, TK, Jain, P, Chambers, JC, Kooner, JS, Senior, R. Normative reference values for the tissue Doppler imaging parameters of left ventricular function: a population-based study. Eur J Echocardiogr 2010; 11: 5156.
27. Heiberg, J, Ringgaard, S, Schmidt, MR, Redington, A, Hjortdal, VE. Structural and functional alterations of the right ventricle are common in adults operated for ventricular septal defect as toddlers. Eur Heart J Cardiovasc Imag 2015; 16: 483489.
28. Opotowsky, AR. Abnormal spirometry in congenital heart disease: where do we go from here? Circulation 2013; 127: 865867.
29. Rigolin, VH, Li, JS, Hanson, MW, et al. Role of right ventricular and pulmonary functional abnormalities in limiting exercise capacity in adults with congenital heart disease. Am J Cardiol 1997; 80: 315322.
30. Ginde, S, Bartz, PJ, Hill, GD, et al. Restrictive lung disease is an independent predictor of exercise intolerance in the adult with congenital heart disease. Congenit Heart Dis 2013; 8: 246254.
31. Alonso-Gonzalez, R, Borgia, F, Diller, GP, et al. Abnormal lung function in adults with congenital heart disease: prevalence, relation to cardiac anatomy, and association with survival. Circulation 2013; 127: 882890.
32. Diller, GP, Dimopoulos, K, Okonko, D, et al. Exercise intolerance in adult congenital heart disease: comparative severity, correlates, and prognostic implication. Circulation 2005; 112: 828835.
33. Dimopoulos, K, Diller, GP, Piepoli, MF, Gatzoulis, MA. Exercise intolerance in adults with congenital heart disease. Cardiol Clin 2006; 24: 641660.
34. Kempny, A, Dimopoulos, K, Uebing, A, et al. Reference values for exercise limitations among adults with congenital heart disease. Relation to activities of daily life – single centre experience and review of published data. Eur Heart J 2012; 33: 13861396.
35. Engelfriet, P, Boersma, E, Oechslin, E, et al. The spectrum of adult congenital heart disease in Europe: morbidity and mortality in a 5 year follow-up period: The Euro Heart Survey on adult congenital heart disease. Eur Heart J 2005; 26: 23252333.
36. Gabriels, C, De Backer, J, Pasquet, A, et al. Long-term outcome of patients with perimembranous ventricular septal defect: results from the Belgian registry on adult congenital heart disease. Cardiology 2017; 136: 147155.
37. Meijboom, F, Szatmari, A, Utens, E, et al. Long-term follow-up after surgical closure of ventricular septal defect in infancy and childhood. J Am Coll Cardiol 1994; 24: 13581364.
38. Baumgartner, H, Bonhoeffer, P, De Groot, NM, et al. ESC Guidelines for the management of grown-up congenital heart disease (new version 2010). Eur Heart J 2010; 31: 29152957.
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Cardiology in the Young
  • ISSN: 1047-9511
  • EISSN: 1467-1107
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