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Disappearance of the shunt and lower cardiac index during exercise in small, unrepaired ventricular septal defects

Published online by Cambridge University Press:  25 March 2020

Marie Maagaard Open the ORCID record for Marie Maagaard [Opens in a new window] ,
Filip Eckerström ,
Johan Heiberg Open the ORCID record for Johan Heiberg [Opens in a new window] ,
Benjamin Asschenfeldt Open the ORCID record for Benjamin Asschenfeldt [Opens in a new window] ,
Steffen Ringgaard  and
Vibeke E. Hjortdal
Marie Maagaard*
Affiliation:
Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens Blv. 99, DK-8200Aarhus N, Denmark Department of Clinical Medicine, Aarhus University Hospital, Palle Juul-Jensens Blv. 99, DK-8200Aarhus N, Denmark
Filip Eckerström
Affiliation:
Department of Clinical Medicine, Aarhus University Hospital, Palle Juul-Jensens Blv. 99, DK-8200Aarhus N, Denmark
Johan Heiberg
Affiliation:
Department of Clinical Medicine, Aarhus University Hospital, Palle Juul-Jensens Blv. 99, DK-8200Aarhus N, Denmark
Benjamin Asschenfeldt
Affiliation:
Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens Blv. 99, DK-8200Aarhus N, Denmark Department of Clinical Medicine, Aarhus University Hospital, Palle Juul-Jensens Blv. 99, DK-8200Aarhus N, Denmark
Steffen Ringgaard
Affiliation:
The MR Research Centre, Aarhus University Hospital, Palle Juul-Jensens Blv. 99, DK-8200Aarhus N, Denmark
Vibeke E. Hjortdal
Affiliation:
Department of Clinical Medicine, Aarhus University Hospital, Palle Juul-Jensens Blv. 99, DK-8200Aarhus N, Denmark
*
Author for correspondence: M. Maagaard, MD, PhD, Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens Blv. 99, DK-8200Aarhus N, Denmark. Tel: +45 7845 3086; Fax: +45 7845 3079. E-mail: [email protected]
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Abstract

Objectives:

Clinical studies have revealed decreased exercise capacity in adults with small, unrepaired ventricular septal defects. Increasing shunt ratio and growing incompetence of the aortic and pulmonary valve with retrograde flow during exercise have been proposed as reasons for the previously found reduced exercise parameters. With MRI, haemodynamic shunt properties were measured during exercise in ventricular septal defects.

Methods:

Patients with small, unrepaired ventricular septal defects and healthy peers were examined with MRI during exercise. Quantitative flow scans measured blood flow through ascending aorta and pulmonary artery. Scans were analysed post hoc where cardiac index, retrograde flows, and shunt ratio were determined.

Results:

In total, 32 patients (26 ± 6 years) and 28 controls (27 ± 5 years) were included. The shunt ratio was 1.2 ± 0.2 at rest and decreased to 1.0 ± 0.2 at peak exercise, p < 0.01. Aortic cardiac index was lower at peak exercise in patients (7.5 ± 2 L/minute/m2) compared with controls (9.0±2L l/minute/m2), p<0.01. Aortic and pulmonary retrograde flow was larger in patients during exercise, p < 0.01. Positive correlation was demonstrated between aortic cardiac index at peak exercise and previously established exercise capacity for all patients (r = 0.5, p < 0.01).

Conclusions:

Small, unrepaired ventricular septal defects revealed declining shunt ratio with increasing exercise and lower aortic cardiac index. Patients demonstrated larger retrograde flow both through the pulmonary artery and the aorta during exercise compared with controls. In conclusion, adults with unrepaired ventricular septal defects redistribute blood flow during exercise probably secondary to a more fixed pulmonary vascular resistance compared with age-matched peers.

Keywords

Ventricular septal defectsbicycle exercise testMRIadult congenital heart disease
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 4 , April 2020 , pp. 526 - 532
Copyright
© The Author(s), 2020. Published by Cambridge University Press

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