Right ventricular pressure during exercise in adolescents with atrial or ventricular septal defect

  • Mr Thomas Möller, Pediatric Department, Vestfold Hospital Trust, Norway
  • Mr Henrik Brun, Norway
  • Mr Per Morten Fredriksen, Division of Rehabilitation, Rikshospitalet University Hospital, Oslo, Norway
  • Mr Henrik Holmstrøm, Pediatric Cardiology, Pulmology and Allergy, Rikshospitalet University Hospital, Oslo, Norway
  • Mrs Kari Peersen, Department of Cardiology, Vestfold Hospital Trust, Tønsberg, Norway
  • Mr Eirik Pettersen, Department of Cardiology, Rikshospitalet University Hospital, Oslo, Norway
  • Mr Ekkehard Grünig, Thoraxklinik University Hospital, Heidelberg, Germany
  • Mr Erik Thaulow, Norway

    • Background: Prevalence of pulmonary arterial hypertension (PAH) in adults with either closed atrial septal defect (ASD) or closed ventricular septal defect (VSD) has been reported to be 18% and 26% respectively. Abnormal right ventricular systolic pressure (RVSP) response during exercise has been identified as a precursor of PAH. Our study investigated abnormal RVSP response in young patients with isolated ASD or VSD.
    Methods and results: The study comprised a population-based selection of 45 patients (age 13 – 25 yrs) with either isolated VSD (n=27) or ASD (n=19) and with no right ventricular outflow tract obstruction. 30 defects had been closed (all ASD, 11 VSD). Cardiovascular exercise testing and echocardiography at rest and during exercise were performed in all patients and in 90 healthy controls. NT-pro-BNP and inflammation markers were analysed in the patient group. Aerobic capacity was significantly reduced in all patient groups. Parameters of right ventricular performance were significantly lower in closed ASD and closed VSD as compared to controls and to patients with open VSD. Four of 87 controls (5 %), one patient with ASD (6 %) and 9 patients with VSD (33 %), regardless defect closure, showed abnormal RVSP response above 50 mmHg during exercise.
    Conclusion: One third of young patients with isolated VSD have abnormal right ventricular systolic pressure response during exercise without signs of right ventricular outflow tract obstruction. Patients with isolated ASD or VSD have reduced aerobic exercise capacity and patients with closed defect also show reduced right ventricular performance at rest.