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Xue YH, Huang IC, Tuan SH, Cheng CC, Cheng H, Lu YS, Chou CC, Chang YL, Lin KL. Cardiopulmonary functional capacity in Taiwanese children with atrial septal defects. J Chin Med Assoc 2024; 87:653-658. [PMID: 38666778 DOI: 10.1097/jcma.0000000000001102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Most existing studies measure atrial septal defect (ASD) outcomes based on morbidity rates such as atrial arrhythmias and heart failure rather than the functional assessment of physical capacity postprocedure. Few studies have evaluated cardiopulmonary function in ASD children. This study represents the largest sample population in the current research, encompassing a total of 122 Taiwanese children with ASD who had undergone treatment, to evaluate cardiopulmonary functional capacity through the implementation of cardiopulmonary exercise testing (CPET), and to investigate whether variations in treatment may impact their cardiopulmonary function. METHODS This is a retrospective cohort study with the data collected from January 2010 to December 2021. All patients and controls (age-, sex-, and body mass index-matched) underwent CPET and pulmonary function testing. RESULTS In total, 122 ASD patients (surgically closed ASDs 27, transcatheter-closed ASDs 48, and follow-up unrepaired ASD 47) and 244 healthy controls were recruited. The ASD group exhibited lower peak metabolic equivalent (MET), peak oxygen consumption (VO 2 , p < 0.001), and peak minute ventilation ( p = 0.028) along with MET and VO 2 at the anaerobic threshold (AT) ( p = 0.012) compared to the control group. No statistically significant differences were observed in the pulmonary function test. Among surgically closed, transcatheter closed and unrepaired ASD subgroups, no significant variances were seen in CPET and pulmonary function tests. CONCLUSION Taiwanese ASD children exhibited diminished exercise capacity and cardiopulmonary performance compared to their healthy counterparts. Differences among specific ASD treatments in cardiopulmonary tests were non-significant.
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Affiliation(s)
- Yu-Hao Xue
- Department of Physical Medicine and Rehabilitation, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC
| | - I-Ching Huang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC
| | - Sheng-Hui Tuan
- Department of Physical Medicine and Rehabilitation, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC
- Department of Rehabilitation Medicine, Cishan Hospital, Ministry of Health and Welfare, Kaohsiung, Taiwan, ROC
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
| | - Cheng-Chang Cheng
- Department of Physical Medicine and Rehabilitation, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC
| | - Hsuan Cheng
- Department of General Medicine, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan, ROC
| | - Yen-Sen Lu
- Department of Physical Medicine and Rehabilitation, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC
| | - Chia-Chun Chou
- Department of Physical Medicine and Rehabilitation, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC
| | - Yung-Liang Chang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC
| | - Ko-Long Lin
- Department of Physical Medicine and Rehabilitation, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
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Magruder ML, Gordon AM, Ng MK, Capotosto S, Wong CHJ, Sculco P. Postoperative Complications, Readmissions, Lengths of Stay, and Cost Analyses of Patients Who Have Atrial Septal Defects After Total Joint Arthroplasty. J Arthroplasty 2023; 38:2126-2130. [PMID: 37172797 DOI: 10.1016/j.arth.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 04/30/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Atrial septal defects (ASDs) are a common congenital heart defect. This study aimed to determine whether patients diagnosed with ASDs undergoing total joint arthroplasty have differences in 1) medical complications, 2) readmissions, 3) lengths of stay (LOS), and 4) costs. METHODS Using an administrative claims data set, a retrospective query from 2010 to 2020 was performed. The ASD patients were 1:5 ratio matched with controls, yielding a total of 45,695 total knee arthroplasty (TKA) (ASD = 7,635, control = 38,060) and 18,407 total hip arthroplasty (THA) (ASD = 3,084, control = 15,323) patients. Outcomes included medical complications, readmissions, LOS, and costs. Logistical regressions were used to calculate odds ratios (ORs) and P values. P values < 0.001 were significant. RESULTS The ASD patients had higher odds of medical complications after TKA (38.8 versus 21.0%; OR 2.09; P < .001) and THA (45.2 versus 23.5%; OR 2.1; P < .001), noticeably deep vein thromboses, strokes, and other thromboembolic complications. The ASD patients were not significantly more likely to be readmitted after TKA (5.3 versus 4.7%; OR 1.13; P = .033) or THA (6.0 versus 5.7%; OR 1.05; P = .531). Patient LOS was not significantly greater in ASD patients undergoing TKA (3.2 versus 3.2 days; P = .805) but was greater after THA (5.3 versus 3.76 days; P < .001). Same-day surgery costs were not significantly increased in ASD patients after TKA ($23,892.53 versus $23,453.40; P = .066) but were after THA ($23,981.93 versus $23,579.18; P < .001). Costs within 90 days were similar between cohorts. CONCLUSION The ASD patients have greater 90-day complications following primary total joint arthroplasty. Providers may consider preoperative cardiac clearance or adjusting anticoagulation in this population to mitigate these risks. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Matthew L Magruder
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Adam M Gordon
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York; Questrom School of Business, Boston University, Boston, Massachusetts
| | - Mitchell K Ng
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Salvatore Capotosto
- Renaissance School of Medicine at Stony Brook University, Stony Brook, New York
| | - Che Hang Jason Wong
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Peter Sculco
- Hospital for Special Surgery, Adult Reconstruction and Joint Replacement, New York, New York
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Forton K, Lamotte M, Gillet A, Chaumont M, van de Borne P, Faoro V. Beta-Adrenergic Receptor Blockade Effects on Cardio-Pulmonary Exercise Testing in Healthy Young Adults: A Randomized, Placebo-Controlled Trial. SPORTS MEDICINE - OPEN 2022; 8:150. [PMID: 36538192 PMCID: PMC9768047 DOI: 10.1186/s40798-022-00537-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 11/17/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Beta-blockers are increasingly prescribed while the effects of beta-adrenergic receptor blockade on cardio-pulmonary exercise test (CPET)-derived parameters remain under-studied. METHODS Twenty-one young healthy adults repeated three CPET at the same time with an interval of 7 days between each test. The tests were performed 3 h after a random, double-blind, cross-over single-dose intake of placebo, 2.5 mg or 5.0 mg bisoprolol, a cardio-selective beta1-adrenoreceptor antagonist. Gas exchange, heart rate (HR) and blood pressure (BP) were measured at rest and during cyclo-ergometric incremental CPET. RESULTS Maximal workload and VO2max were unaffected by the treatment, with maximal respiratory exchange ratio > 1.15 in all tests. A beta-blocker dose-dependent effect reduced resting and maximal BP and HR and the chronotropic response to exercise, evaluated by the HR/VO2 slope (placebo: 2.9 ± 0.4 beat/ml/kg; 2.5 mg bisoprolol: 2.4 ± 0.5 beat/ml/kg; 5.0 mg bisoprolol: 2.3 ± 0.4 beat/ml/kg, p < 0.001). Ventilation efficiency measured by the VE/VCO2 slope and the ventilatory equivalent for CO2 at the ventilatory threshold were not affected by beta1-receptor blockade. Post-exercise chronotropic recovery measured after 1 min was enhanced under beta1-blocker (placebo: 26 ± 7 bpm; 2.5 mg bisoprolol: 32 ± 6 bpm; 5.0 mg bisoprolol: 33 ± 6 bpm, p < 0.01). CONCLUSION The present results suggest that a single dose of bisoprolol does not affect metabolism, respiratory response and exercise capacity. However, beta-adrenergic blockade dose dependently reduces exercise hemodynamic response by lowering BP and the chronotropic response.
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Affiliation(s)
- Kevin Forton
- grid.4989.c0000 0001 2348 0746Cardio-Pulmonary Exercise Laboratory, Faculty of Motor Sciences, Université Libre de Bruxelles, Erasme Campus CP 604, 808 Lennik Road, 1070 Brussels, Belgium ,grid.4989.c0000 0001 2348 0746Department of Cardiology, Erasmus University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Michel Lamotte
- grid.4989.c0000 0001 2348 0746Department of Cardiology, Erasmus University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Alexis Gillet
- grid.4989.c0000 0001 2348 0746Cardio-Pulmonary Exercise Laboratory, Faculty of Motor Sciences, Université Libre de Bruxelles, Erasme Campus CP 604, 808 Lennik Road, 1070 Brussels, Belgium ,grid.4989.c0000 0001 2348 0746Department of Cardiology, Erasmus University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Martin Chaumont
- grid.4989.c0000 0001 2348 0746Cardio-Pulmonary Exercise Laboratory, Faculty of Motor Sciences, Université Libre de Bruxelles, Erasme Campus CP 604, 808 Lennik Road, 1070 Brussels, Belgium ,grid.4989.c0000 0001 2348 0746Department of Cardiology, Erasmus University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Philippe van de Borne
- grid.4989.c0000 0001 2348 0746Department of Cardiology, Erasmus University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Vitalie Faoro
- grid.4989.c0000 0001 2348 0746Cardio-Pulmonary Exercise Laboratory, Faculty of Motor Sciences, Université Libre de Bruxelles, Erasme Campus CP 604, 808 Lennik Road, 1070 Brussels, Belgium
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D'Alto M, Constantine A, Chessa M, Santoro G, Gaio G, Giordano M, Romeo E, Argiento P, Wacker J, D'Aiello AF, Sarubbi B, Russo MG, Naeije R, Golino P, Dimopoulos K. Fluid challenge and balloon occlusion testing in patients with atrial septal defects. Heart 2021; 108:848-854. [PMID: 34413090 DOI: 10.1136/heartjnl-2021-319676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 08/10/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Careful, stepwise assessment is required in all patients with atrial septal defect (ASD) to exclude pulmonary vascular or left ventricular (LV) disease. Fluid challenge and balloon occlusion may unmask LV disease and post-capillary pulmonary hypertension, but their role in the evaluation of patients with 'operable' ASDs is not well established. METHODS We conducted a prospective study in three Italian specialist centres between 2018 and 2020. Patients selected for percutaneous ASD closure underwent assessment at baseline and after fluid challenge, balloon occlusion and both. RESULTS Fifty patients (46 (38.2, 57.8) years, 72% female) were included. All had a shunt fraction >1.5, pulmonary vascular resistance (PVR) <5 Wood Units (WU) and pulmonary arterial wedge pressure (PAWP) <15 mm Hg. Individuals with a PVR ≥2 WU at baseline (higher PVR group) were older, more symptomatic, with a higher baseline systemic vascular resistance (SVR) than the lower PVR group (all p<0.0001). Individuals with a higher PVR experienced smaller increases in pulmonary blood flow following fluid challenge (0.3 (0.1, 0.5) vs 2.0 (1.5, 2.8) L/min, p<0.0001). Balloon occlusion led to a more marked fall in SVR (p<0.0001) and a larger increase in systemic blood flow (p=0.024) in the higher PVR group. No difference was observed in PAWP following fluid challenge and/or balloon occlusion between groups; four (8%) patients reached a PAWP ≥18 mm Hg following the addition of fluid challenge to balloon occlusion testing. CONCLUSIONS In adults with ASD without overt LV disease, even small rises in PVR may have significant implications on cardiovascular haemodynamics. Fluid challenge may provide additional information to balloon occlusion in this setting.
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Affiliation(s)
- Michele D'Alto
- Department of Cardiology, University 'L Vanvitelli' - Monaldi Hospital, Naples, Italy
| | - Andrew Constantine
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Massimo Chessa
- Pediatric Cardiology Department and GUCH Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Giuseppe Santoro
- Heart Hospital "G. Pasquinucci", National Research Council - Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Gianpiero Gaio
- Paediatric Cardiology, University 'L Vanvitelli' - Monaldi Hospital, Naples, Italy
| | - Mario Giordano
- Paediatric Cardiology, University 'L Vanvitelli' - Monaldi Hospital, Naples, Italy
| | - Emanuele Romeo
- Department of Cardiology, University 'L Vanvitelli' - Monaldi Hospital, Naples, Italy
| | - Paola Argiento
- Department of Cardiology, University 'L Vanvitelli' - Monaldi Hospital, Naples, Italy
| | - Julie Wacker
- Pediatric Cardiology Department and GUCH Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Angelo Fabio D'Aiello
- Pediatric Cardiology Department and GUCH Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Berardo Sarubbi
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Naples, Italy
| | - Maria Giovanna Russo
- Paediatric Cardiology, University 'L Vanvitelli' - Monaldi Hospital, Naples, Italy
| | - Robert Naeije
- Department of Pathophysiology, Free University of Brussels Campus de la Plaine, Brussels, Belgium
| | - Paolo Golino
- Department of Cardiology, University 'L Vanvitelli' - Monaldi Hospital, Naples, Italy
| | - Konstantinos Dimopoulos
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
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Reduced Parasympathetic Activity in Patients With Different Types of Congenital Heart Disease and Associations to Exercise Capacity. J Cardiopulm Rehabil Prev 2020; 41:35-39. [PMID: 33201003 DOI: 10.1097/hcr.0000000000000511] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Current research indicates an imbalance in the autonomic nervous system (ANS) pathway activities in patients with congenital heart disease (CHD). The heart rate variability (HRV) is a measure to quantify activities of the parasympathetic and sympathetic branches. This study evaluated the parasympathetic activity by means of HRV in patients with CHD, regarding diagnostic subgroups and CHD severity, and the association to exercise capacity. METHODS From July 2016 to August 2018, a total of 222 patients with different types of CHD (28.4 ± 10.1 yr; 44% female) received breathing-controlled HRV measurement in the supine position. Based on 130 adjacent heartbeats, the root mean square of successive differences (RMSSD), a parasympathetic activity surrogate was estimated and log-transformed. Additionally, all patients underwent a cardiopulmonary exercise test. For comparison, a control group (CG) of 57 (29.0 ± 7.1 yr; 61% female) healthy volunteers was recruited. RESULTS Patients with CHD exhibited reduced parasympathetic activity in comparison to the CG (lnRMSSD CHD: 3.55 ± 0.57 ms vs CG: 3.93 ± 0.55 ms; P < .001), with the lowest parasympathetic activity in patients with Fontan circulation (3.07 ± 0.54 ms; P < .001). Complex CHD (3.40 ± 0.54 ms) had worse values compared with patients with simple (3.87 ± 0.55 ms; P < .001) and moderate severity (3.74 ± 0.54 ms; P < .001). Better parasympathetic activity in CHD patients was associated with increased exercise capacity (r = 0.322; P < .001). CONCLUSIONS Impaired parasympathetic activity suggests limited function of the ANS in patients with CHD. Further studies should focus on the association of exercise capacity and ANS to possibly improve parasympathetic activity and functional outcomes.
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Andersen KS, Laustsen S, Petersen AK. Correlation Between Exercise Capacity and Quality of Life in Patients With Cardiac Disease. J Cardiopulm Rehabil Prev 2019; 38:297-303. [PMID: 28885281 DOI: 10.1097/hcr.0000000000000281] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Patients are referred to exercise-based cardiac rehabilitation (ECR) to increase exercise capacity and health-related quality of life (HRQOL) and thereby reduce risk of morbidity and mortality. The purpose of this study was to examine the correlation between exercise capacity and HRQOL. Furthermore, this study examined whether improvements in HRQOL were directly related to improvements in exercise capacity. METHODS The study included 277 patients participating in ECR. HRQOL was assessed using the Medical Outcomes Study 36-item Short Form Health Survey (SF-36), and exercise capacity was measured as peak oxygen uptake ((Equation is included in full-text article.)O2peak) and oxygen uptake ((Equation is included in full-text article.)O2) at the ventilatory threshold (VTh). Patients were examined before and after completion of an 8-wk ECR program. RESULTS Analyses at baseline showed a significant correlation between (Equation is included in full-text article.)O2peak and VTh and physical functioning (PF), role limitations because of physical problems (RP), general health perceptions (GH), vitality (VT), and physical component summary (PCS) on the SF-36; PF was the only dimension showing a moderate correlation (>0.40 Spearman ρ) with (Equation is included in full-text article.)O2peak. The follow-up analyses demonstrated a significant correlation between changes in (Equation is included in full-text article.)O2peak and changes in PF, RP, VT, and MH. Changes in (Equation is included in full-text article.)O2 peak explained 4% of the changes in the PF and VT scores. CONCLUSION The correlations between exercise capacity and HRQOL were weak and varied considerably among patients. The ECR program improved both exercise capacity and HRQOL, but it was not necessarily the same patients who improved both parameters. Therefore, it is recommended to use separate objective measures and patient-reported outcomes when evaluating the effect of ECR.
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Affiliation(s)
- Karoline Stentoft Andersen
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark (Ms Andersen and Drs Laustsen and Petersen); Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark (Dr Laustsen); Centre of Research in Rehabilitation, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark (Ms Andersen and Drs Laustsen and Petersen)
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Filaire L, Chalard A, Perrault H, Trésorier R, Lusson JR, Pereira B, Costes F, Dauphin C, Richard R. Validation of intracardiac shunt using thoracic bioimpedance and inert gas rebreathing in adults before and after percutaneous closure of atrial septal defect in a cardiology research unit: study protocol. BMJ Open 2019; 9:e024389. [PMID: 31133575 PMCID: PMC6538205 DOI: 10.1136/bmjopen-2018-024389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Intrathoracic shunt quantification is a major factor for appropriate clinical management of heart and pulmonary diseases. Intracardiac shunts quantified by pulmonary to systemic output ratio (Qp/Qs) are generally assessed by Doppler echocardiography, MRI or catheterisation. Recently, some authors have suggested the concomitant use of thoracic bioimpedance (TB) and inert gas rebreathing (IGR) techniques for shunt quantification. The purpose of this study is to validate the use of this approach under conditions where shunt fraction is directly quantified such as in patients with isolated atrial septal defect (ASD). METHODS AND ANALYSIS This trial is a prospective, observational single-centre, non-blinded study of adults seen for percutaneous closure of ASD. Qp/Qs ratio will be directly measured by Doppler echocardiography and direct Fick. IGR and TB will be used simultaneously to measure the cardiac output before and after closure: the ratio of outputs measured by IGR and TB reflecting the shunt fraction. The primary outcome will be the comparison of shunt values measured by TB-IGR and Doppler echocardiography. ETHICS AND DISSEMINATION The study has been approved by an independent Research Ethics Committee (2017-A03149-44 Fr) and registered as an official clinical trial. The results will be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT03437148; Pre-results.
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Affiliation(s)
- Laura Filaire
- Thoracic and Endocrine Surgery, Centre Jean Perrin, Clermont-Ferrand, France
| | - Aurelie Chalard
- Cardiology and Vascular Department, Hopital Gabriel Montpied, Clermont-Ferrand, France
| | - Hélène Perrault
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Respiratory and Epidemiology Clinical Research Unit, Montreal Chest Institute, Montreal, Quebec, Canada
| | - Romain Trésorier
- Cardiology and Vascular Department, Hopital Gabriel Montpied, Clermont-Ferrand, France
| | - Jean-René Lusson
- Cardiology and Vascular Department, Hopital Gabriel Montpied, Clermont-Ferrand, France
| | - Bruno Pereira
- Biostatistics Unit, Hopital Gabriel Montpied, Clermont-Ferrand, France
| | - Frederic Costes
- Department of Physiology and Medical Sport, Hopital Gabriel Montpied, Clermont-Ferrand, France
- INRA, UMR 1018, UNH, Université d’Auvergne, Centre de Recherche en Nutrition Humaine Auvergne, Clermont-Ferrand, France
| | - Claire Dauphin
- Cardiology and Vascular Department, Hopital Gabriel Montpied, Clermont-Ferrand, France
| | - Ruddy Richard
- Respiratory and Epidemiology Clinical Research Unit, Montreal Chest Institute, Montreal, Quebec, Canada
- Department of Physiology and Medical Sport, Hopital Gabriel Montpied, Clermont-Ferrand, France
- INRA, UMR 1018, UNH, Université d’Auvergne, Centre de Recherche en Nutrition Humaine Auvergne, Clermont-Ferrand, France
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Amedro P, Guillaumont S, Bredy C, Matecki S, Gavotto A. Atrial septal defect and exercise capacity: value of cardio-pulmonary exercise test in assessment and follow-up. J Thorac Dis 2018; 10:S2864-S2873. [PMID: 30305946 DOI: 10.21037/jtd.2017.11.30] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Nearly four decades ago, the World Health Organization stated that functional capacity explorations best reflected the impact of a chronic disease on quality of life. Today, cardio-pulmonary exercise test (CPET) is recommended in the follow-up of patients with congenital heart diseases (CHDs). Indeed, the maximum oxygen uptake (VO2max) and the ventilatory efficiency (VE/VCO2 slope) correlate with both the prognosis and the quality of life in this population. Atrial septal defects (ASDs) represent the second most frequent CHD and are usually considered as simple CHDs. However, the exercise capacity of ASD patients may be impaired. Therefore, the CPET provides important information in assessment and follow-up of patients with ASDs, for both children and adults. Exercise capacity of patients with unrepaired ASDs depends on the importance of the shunt, the right ventricular (RV) function and volume overload, the level of pulmonary arterial pressure, and the occurrence of arrhythmias. For repaired ASDs, exercise capacity also depends on the delay before closure and the type of procedure (catheter or surgery). In most cases, the exercise capacity is nearly normal and CPET contributes to promote sports participation. In addition, a regular CPET follow-up is necessary to evaluate the occurrence, severity and physiological mechanisms of comorbidities, i.e., heart failure, pulmonary hypertension and arrhythmia. Furthermore, CPET follow-up in patients with ASDs may detect early onset of muscular deconditioning, for which cardiac rehabilitation may be considered.
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Affiliation(s)
- Pascal Amedro
- Paediatric and Adult Congenital Cardiology Department, M3C Regional Reference CHD Centre, University Hospital, Montpellier, France.,Physiology and Experimental Biology of Heart and Muscles Laboratory-PHYMEDEXP, UMR CNRS 9214, INSERM U1046, University of Montpellier, Montpellier, France.,Functional Exploration Laboratory, Physiology Department, University Hospital, Montpellier, France
| | - Sophie Guillaumont
- Paediatric and Adult Congenital Cardiology Department, M3C Regional Reference CHD Centre, University Hospital, Montpellier, France.,Paediatric Cardiology and Rehabilitation Unit, St-Pierre Institute, Palavas-Les-Flots, France.,Functional Exploration Laboratory, Physiology Department, University Hospital, Montpellier, France
| | - Charlene Bredy
- Paediatric and Adult Congenital Cardiology Department, M3C Regional Reference CHD Centre, University Hospital, Montpellier, France.,Functional Exploration Laboratory, Physiology Department, University Hospital, Montpellier, France
| | - Stefan Matecki
- Physiology and Experimental Biology of Heart and Muscles Laboratory-PHYMEDEXP, UMR CNRS 9214, INSERM U1046, University of Montpellier, Montpellier, France.,Functional Exploration Laboratory, Physiology Department, University Hospital, Montpellier, France
| | - Arthur Gavotto
- Paediatric and Adult Congenital Cardiology Department, M3C Regional Reference CHD Centre, University Hospital, Montpellier, France.,Paediatric Cardiology and Rehabilitation Unit, St-Pierre Institute, Palavas-Les-Flots, France
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Le Gloan L, Legendre A, Iserin L, Ladouceur M. Pathophysiology and natural history of atrial septal defect. J Thorac Dis 2018; 10:S2854-S2863. [PMID: 30305945 DOI: 10.21037/jtd.2018.02.80] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Atrial septal defects are among the third most common types of congenital heart disease. This group of malformations includes several types of atrial communications allowing shunting of blood between the systemic and the pulmonary circulations. The nature of shunting across the defect in patients with atrial septal defect is of particular interest. Understanding the underlying mechanisms of interatrial shunts and their natural history will help selecting the best timing for closure, before irreversible cardiac and pulmonary injury occur. This review describes the different pathophysiologic mechanisms involved in the direction and magnitude of blood flow through atrial septal defects. The natural history of an individual born with an isolated atrial septal defect is then discussed, including the impact of a longstanding shunt on survival.
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Affiliation(s)
- Laurianne Le Gloan
- Department of Cardiology, Adult Congenital Heart Disease. Institut du thorax, CHU de Nantes, Université de Nantes, boulevard Jacques Monod, Saint-Herblain, France
| | - Antoine Legendre
- Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Cardiology, Adult Congenital Heart Disease Unit, Centre de référence des Malformations Cardiaques Congénitales Complexes, M3C, Paris, France
| | - Laurence Iserin
- Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Cardiology, Adult Congenital Heart Disease Unit, Centre de référence des Malformations Cardiaques Congénitales Complexes, M3C, Paris, France
| | - Magalie Ladouceur
- Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Cardiology, Adult Congenital Heart Disease Unit, Centre de référence des Malformations Cardiaques Congénitales Complexes, M3C, Paris, France.,INSERM U970, PARCC, Paris Descartes University, Sorbonne Paris Cité, Paris, France
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10
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Bredy C, Mongeon FP, Leduc L, Dore A, Khairy P. Pregnancy in adults with repaired/unrepaired atrial septal defect. J Thorac Dis 2018; 10:S2945-S2952. [PMID: 30305955 DOI: 10.21037/jtd.2017.10.130] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Atrial septal defect (ASD) is the most common form of congenital heart disease. Left-to-right shunting leads to right ventricular (RV) volume overload with excessive pulmonary blood flow. Complications include exercise intolerance, pulmonary vascular disease, RV dysfunction, paradoxical thromboemboli, and atrial arrhythmias. Women with coexisting severe pulmonary hypertension should be counselled against pregnancy due to high incidence of maternal and fetal morbidity and mortality. In the absence of pulmonary hypertension, pregnancy is generally well tolerated in the setting of an ASD. Nevertheless, hemodynamic changes throughout gestation may increase the risk for complications, particularly in those with unrepaired ASDs. Arrhythmias are the most common cardiac event and occur in 4-5%, followed by paradoxical emboli in 2-5%. Obstetrical and neonatal complications include preeclampsia, a higher incidence of infants born small for gestational age, and higher fetal/perinatal mortality. Although there is no definitive evidence demonstrating superiority of an aggressive approach to ASD closure prior to pregnancy, it is currently common practice to electively close asymptomatic but large and/or hemodynamically significant ASDs prior to childbearing. Cardiology follow up during pregnancy should be adapted to clinical circumstances and includes transthoracic echocardiography during the second trimester and arrhythmia monitoring in the event of symptoms.
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Affiliation(s)
- Charlène Bredy
- Adult Congenital Heart Centre, Montreal Heart Institute, CHUS Ste-Justine, Université de Montréal, Montreal, Canada
| | - François-Pierre Mongeon
- Adult Congenital Heart Centre, Montreal Heart Institute, CHUS Ste-Justine, Université de Montréal, Montreal, Canada
| | - Line Leduc
- Department of Obstetrics, CHUS Ste-Justine, Université de Montréal, Montreal, Canada
| | - Annie Dore
- Adult Congenital Heart Centre, Montreal Heart Institute, CHUS Ste-Justine, Université de Montréal, Montreal, Canada
| | - Paul Khairy
- Adult Congenital Heart Centre, Montreal Heart Institute, CHUS Ste-Justine, Université de Montréal, Montreal, Canada
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Heiberg J, Nyboe C, Hjortdal VE. Permanent chronotropic impairment after closure of atrial or ventricular septal defect. SCAND CARDIOVASC J 2017; 51:271-276. [DOI: 10.1080/14017431.2017.1337216] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Johan Heiberg
- Department of Cardiothoracic & Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Camilla Nyboe
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Anesthesiology & Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Vibeke E. Hjortdal
- Department of Cardiothoracic & Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
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Heiberg J, Nyboe C, Hjortdal VE. Impaired ventilatory efficiency after closure of atrial or ventricular septal defect. SCAND CARDIOVASC J 2017; 51:221-227. [PMID: 28502187 DOI: 10.1080/14017431.2017.1326623] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Atrial and ventricular septal defects are the most common congenital heart defects and the closing procedures share important similarities. Generally, the postoperative outcome is considered benign, but there is growing concern regarding late ventilatory function. Therefore, the aim of this review was to describe the ventilatory function in patients with open as well as percutaneously or surgically closed atrial and ventricular septal defects. METHODS We performed a search protocol based on the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" (PRISMA) guidelines. A data collection form was specifically developed and data were extracted from the included studies by a primary reviewer and cross-checked by the secondary reviewer. RESULTS We found an increasing evidence of late impairment in ventilatory efficiency, and despite that ventilatory function is commonly normal at rest, abnormalities were disclosed during exercise. There are indices that surgical closure plays an important role. DISCUSSION Atrial septal defect and ventricular septal defect patients have persisting, long-term impairment in ventilatory efficiency during exercise. Although the pathogenesis behind this finding may be multifactorial, there are indices that the surgical procedure may play an important role. Nevertheless, the literature is this field is sparse, and additional studies are needed.
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Affiliation(s)
- Johan Heiberg
- a Department of Cardiothoracic & Vascular Surgery , Aarhus University Hospital, Aarhus , Denmark.,b Department of Clinical Medicine , Aarhus University Hospital, Aarhus , Denmark
| | - Camilla Nyboe
- b Department of Clinical Medicine , Aarhus University Hospital, Aarhus , Denmark.,c Department of Anesthesiology & Intensive Care , Aarhus University Hospital, Aarhus , Denmark
| | - Vibeke E Hjortdal
- a Department of Cardiothoracic & Vascular Surgery , Aarhus University Hospital, Aarhus , Denmark.,b Department of Clinical Medicine , Aarhus University Hospital, Aarhus , Denmark
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Ding C, Chang JK, Lin CC, Wu YJ, Hsieh KS. Efficacy and Safety of Transthoracic Echocardiography Alone in Transcatheter Closure of Secundum-Type Atrial Septal Defects in Adults. Echocardiography 2015; 33:579-85. [PMID: 26522626 DOI: 10.1111/echo.13106] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND On-site transthoracic echocardiography (TTE) to guide the transcutaneous closure of secundum-type atrial septal defects (ASDs) in the catheterization laboratory remains unclear, especially in adults. METHODS Between 2005 and 2012, a total of 82 adults underwent transcutaneous closure of ASDs. The initial 15 cases underwent the procedure with both on-site transesophageal echocardiography (TEE) and TTE monitoring. Since January 2008, a total of 67 patients underwent on-site TTE alone to guide the procedure. RESULTS Among the 82 adult patients who underwent a transcutaneous closure of the secundum-type ASD procedure, all had successful closure of the defects, and no periprocedural adverse complications occurred. No statistical significance was observed in the successful complete shunt closure rate between the TEE plus TTE and TTE groups during sequential follow-up (postprocedure 24 hour [87% vs. 92%],1 month [93% vs. 95%], 3 month [93% vs. 97%], and 12 month [93% vs. 97%], P > 0.05, respectively) nor was a significant difference observed between the two groups, including decreased right ventricular dimension (29.5 ± 3.3 vs. 32.0 ± 4.9 mm, 26.5 ± 3.0 vs. 28.7 ± 4.6 mm, 26.2 ± 3.1 vs. 28.2 ± 4.8 mm, and 25.6 ± 2.8 vs. 27.7 ± 4.7 mm, P > 0.05, respectively) or increased left ventricular end-diastolic dimension (41.1 ± 2.0 vs. 42.6 ± 3.0 mm, 44.3 ± 2.7 vs. 45.5 ± 3.1 mm, 44.2 ± 2.8 vs. 45.4 ± 3.1 mm, 44.9 ± 2.7 vs. 45.8 ± 2.6 mm, P > 0.05, respectively) before the procedure, and at the 3-, 6-, and 12-month follow-up evaluations. CONCLUSION This study showed that TTE guidance alone may be considered efficacious and safe as TEE during a transcutaneous ASD occlusion procedure in select adults.
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Affiliation(s)
- Cheng Ding
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Cardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jia-Kan Chang
- Department of Pediatrics, Cheng-Hsin General Hospital, Taipei, Taiwan
| | - Chang-Chyi Lin
- Division of Cardiology, Department of Internal Medicine, Cheng-Hsin General Hospital, Taipei, Taiwan
| | - Yong-Jian Wu
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Cardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kai-Sheng Hsieh
- Department of Pediatrics, Kaohsiung Chang-Gung Memorial Hospital, Kaohsiung, Taiwan
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Abstract
INTRODUCTION Quality of life has become an important outcome measure in addition to mortality and morbidity in patients with congenital heart disease. Atrial septal defect is a common congenital heart disease, and transcatheter atrial septal defect closure has become an accepted treatment modality. The aim of this study is to assess the quality of life of patients with atrial septal defect who underwent percutaneous closure. MATERIALS AND METHODS We examined the quality of life of 69 patients with atrial septal defect and 69 healthy controls matched according to age, sex, educational level, and economic, marital, and employment status. Quality of life was investigated using the Turkish version of Short Form-36. RESULTS The mean age of the patients was 39.7 ± 14.2 and 26% were male. The quality of life assessment was performed at a mean follow-up time of 18.0 ± 13.8 months after the intervention. The mean scores of the domains of the Short Form-36, namely, physical functioning, role functioning, social functioning, mental health, vitality, pain, and general health, were similar in patients with atrial septal defect who underwent percutaneous closure and the control group. CONCLUSION Adult patients who underwent percutaneous atrial septal defect closure perceive their quality of life to be as good as their healthy counterparts.
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Gabriels C, De Meester P, Pasquet A, De Backer J, Paelinck BP, Morissens M, Van De Bruaene A, Delcroix M, Budts W. A different view on predictors of pulmonary hypertension in secundum atrial septal defect. Int J Cardiol 2014; 176:833-40. [DOI: 10.1016/j.ijcard.2014.08.009] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 07/25/2014] [Accepted: 08/02/2014] [Indexed: 12/21/2022]
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Abstract
Atrial septal defects are the third most common type of congenital heart disease. Included in this group of malformations are several types of atrial communications that allow shunting of blood between the systemic and the pulmonary circulations. Most children with isolated atrial septal defects are free of symptoms, but the rates of exercise intolerance, atrial tachyarrhythmias, right ventricular dysfunction, and pulmonary hypertension increase with advancing age and life expectancy is reduced in adults with untreated defects. The risk of development of pulmonary vascular disease, a potentially lethal complication, is higher in female patients and in older adults with untreated defects. Surgical closure is safe and effective and when done before age 25 years is associated with normal life expectancy. Transcatheter closure offers a less invasive alternative for patients with a secundum defect who fulfil anatomical and size criteria. In this Seminar we review the causes, anatomy, pathophysiology, treatment, and outcomes of atrial septal defects in children and adult patients in whom this defect is the primary cardiac anomaly.
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Affiliation(s)
- Tal Geva
- Department of Cardiology, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
| | - Jose D Martins
- Department of Pediatric Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Rachel M Wald
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University of Toronto, Toronto, ON, Canada
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Klausen SH, Buys R, Andersen LL, Hirth A, McCrindle BW, Kjaergaard H, Wetterslev J. Interventions to increase physical activity for people with congenital heart disease. Hippokratia 2014. [DOI: 10.1002/14651858.cd011030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Susanne H Klausen
- Copenhagen University Hospital, Rigshospitalet; The Research Unit Women and Children's Health, The Juliane Marie Centre; Section 7821 Blegdamsvej 9 Copenhagen Denmark DK 2100
| | - Roselien Buys
- Catholic University of Leuven; Research Center for Cardiovascular and Respiratory Rehabilitation; Tervuursevest 101 Heverlee Belgium 3001
| | - Lars Louis Andersen
- National Research Centre for the Working Environment; Department of Musculoskeletal Disorders; Lersø Parkalle 105 Copenhagen Denmark DK-2100
| | - Asle Hirth
- Haukeland University Hospital; Children's Department; Jonas Lies vei 1 Bergen Norway N-5021
| | - Brian W McCrindle
- The Hospital for Sick Children; University of Toronto; 555 University Avenue Toronto Ontario Canada M5G 1X8
| | | | - Jørn Wetterslev
- Rigshospitalet, Copenhagen University Hospital; Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812; Blegdamsvej 9 Copenhagen Denmark DK-2100
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Current World Literature. Curr Opin Anaesthesiol 2012; 25:260-9. [DOI: 10.1097/aco.0b013e3283521230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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