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

Published online by Cambridge University Press:  06 March 2018

Thomas Moller ,
Harald Lindberg ,
May Brit Lund ,
Henrik Holmstrom ,
Gaute Dohlen  and
Erik Thaulow
Thomas Moller*
Affiliation:
Department of Paediatric Cardiology, Oslo University Hospital, Oslo, Norway
Harald Lindberg
Affiliation:
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway Department of Thoracic Surgery, Oslo University Hospital, Oslo, Norway
May Brit Lund
Affiliation:
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway Department of Respiratory Medicine, Oslo University Hospital, Oslo, Norway
Henrik Holmstrom
Affiliation:
Department of Paediatric Cardiology, Oslo University Hospital, Oslo, Norway Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
Gaute Dohlen
Affiliation:
Department of Paediatric Cardiology, Oslo University Hospital, Oslo, Norway
Erik Thaulow
Affiliation:
Department of Paediatric Cardiology, Oslo University Hospital, Oslo, Norway Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
*
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
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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.

Keywords

CHDventricular septal defectexercise capacityexercise-induced pulmonary arterial hypertension
Type
Original Articles
Information
Cardiology in the Young , Volume 28 , Issue 6 , June 2018 , pp. 797 - 803
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Copyright
© Cambridge University Press 2018 

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