TY - JOUR

T1 - Abnormal ventilatory response to exercise in young adults operated for ventricular septal defect in early childhood

T2 - A long-term follow-up

AU - Heiberg, Johan

AU - Petersen, Annemette K

AU - Laustsen, Sussie

AU - Hjortdal, Vibeke E

N1 - Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

PY - 2015/9/1

Y1 - 2015/9/1

N2 - BACKGROUND: Ventricular septal defects (VSDs) are normally closed in early childhood, and postsurgical physical capacity is generally considered normal. Despite an increasing understanding of late cardiac morbidity among these patients, long-term pulmonary function remains to be investigated. Therefore, the aim of this prospective follow-up study was to describe ventilatory function during exercise in VSD-repaired adults operated in early life.METHODS: We tested cardiopulmonary exercise capacity in 27 patients and 30 healthy control subjects on an ergometer cycle. Each test was preceded by a standard spirometry, and the exercise test was performed as a maximal incremental test. Pulmonary ventilation and gas exchange were simultaneously measured breath-by-breath with minute ventilation at peak exercise as our main endpoint.RESULTS: In the VSD-group the median surgical age was 1.9 (95% CI 1.1-2.8 years) and the mean age at time of examination was 21.1 ± 3.1 years in the VSD-group vs. 21.2 ± 2.5 years in the control group. Mean minute ventilation at peak exercise was significantly lower in the VSD-group compared with the controls: 1.4 ± 0.4 L/kg/min vs. 1.8 ± 0.4 L/kg/min, p<0.01. Likewise, mean oxygen uptake was reduced: 38.0 ± 8.2 ml/kg/min in the VSD-cohort vs. 47.9 ± 6.5 ml/kg/min among controls, p<0.01. In terms of breath rate and ventilatory equivalents (O2 and CO2) there were no differences between the groups.CONCLUSIONS: Patients with a surgically closed VSD have a markedly abnormal ventilatory response to exercise with significantly reduced minute ventilation despite a similar breath rate. With a follow-up of almost two decades our finding most certainly reflects an unknown but persisting abnormality.

AB - BACKGROUND: Ventricular septal defects (VSDs) are normally closed in early childhood, and postsurgical physical capacity is generally considered normal. Despite an increasing understanding of late cardiac morbidity among these patients, long-term pulmonary function remains to be investigated. Therefore, the aim of this prospective follow-up study was to describe ventilatory function during exercise in VSD-repaired adults operated in early life.METHODS: We tested cardiopulmonary exercise capacity in 27 patients and 30 healthy control subjects on an ergometer cycle. Each test was preceded by a standard spirometry, and the exercise test was performed as a maximal incremental test. Pulmonary ventilation and gas exchange were simultaneously measured breath-by-breath with minute ventilation at peak exercise as our main endpoint.RESULTS: In the VSD-group the median surgical age was 1.9 (95% CI 1.1-2.8 years) and the mean age at time of examination was 21.1 ± 3.1 years in the VSD-group vs. 21.2 ± 2.5 years in the control group. Mean minute ventilation at peak exercise was significantly lower in the VSD-group compared with the controls: 1.4 ± 0.4 L/kg/min vs. 1.8 ± 0.4 L/kg/min, p<0.01. Likewise, mean oxygen uptake was reduced: 38.0 ± 8.2 ml/kg/min in the VSD-cohort vs. 47.9 ± 6.5 ml/kg/min among controls, p<0.01. In terms of breath rate and ventilatory equivalents (O2 and CO2) there were no differences between the groups.CONCLUSIONS: Patients with a surgically closed VSD have a markedly abnormal ventilatory response to exercise with significantly reduced minute ventilation despite a similar breath rate. With a follow-up of almost two decades our finding most certainly reflects an unknown but persisting abnormality.

KW - Adolescent

KW - Adult

KW - Case-Control Studies

KW - Child, Preschool

KW - Exercise Test

KW - Exercise Tolerance/physiology

KW - Female

KW - Follow-Up Studies

KW - Heart Septal Defects, Ventricular/physiopathology

KW - Humans

KW - Infant

KW - Male

KW - Oxygen Consumption/physiology

KW - Prospective Studies

KW - Pulmonary Gas Exchange/physiology

KW - Pulmonary Ventilation/physiology

KW - Respiratory Function Tests

KW - Young Adult

U2 - 10.1016/j.ijcard.2015.05.071

DO - 10.1016/j.ijcard.2015.05.071

M3 - Journal article

C2 - 26011258

VL - 194

SP - 2

EP - 6

JO - International Journal of Cardiology

JF - International Journal of Cardiology

SN - 0167-5273

ER -