Article Text

PDF
Right to left shunt through interatrial septal defects in patients with congenital heart disease: results of interventional closure
  1. G Agnoletti,
  2. Y Boudjemline,
  3. P Ou,
  4. D Bonnet,
  5. D Sidi
  1. Necker Enfants Malades, AP HP, Paris, France
  1. Correspondence to:
    Dr Gabriella Agnoletti
    Service de Cardiologie Pédiatrique, Groupe Hospitalier Necker Enfants Malades, AP HP, 149, rue de Sèvres, 75743 Paris, France; gabriella.agnoletti{at}nck.ap-hop-paris.fr

Abstract

Objective: To study the effects of closure of interatrial communications associated with a right to left shunt in patients with congenital heart disease (CHD) who had a biventricular repair.

Design: Retrospective study.

Setting: Tertiary referral centre.

Patients: 15 patients with CHD with right to left shunt through an interatrial communication: three had repaired tetralogy of Fallot, five had repaired pulmonary atresia with intact ventricular septum, four had Ebstein’s disease, and three had other CHDs. Two patients had had a stroke before closure of the interatrial communication.

Interventions: Percutaneous atrial septal defect (n  =  6) or persistent foramen ovale (n  =  9) closure. All patients underwent an exercise test before and after interatrial communication closure.

Results: Five patients were cyanotic at rest. During exercise, mean (SD) oxygen saturation diminished from 93.9 (3.8)% to 84.3 (4.8)% (p < 0.05). Interatrial communication closure led to an immediate increase of oxygen saturation from 93.9 (3.8)% to 98.6 (1.6)% (p < 0.05). At a median follow up of three years (range 0.5–5) all but one patient with a residual atrial septal defect had normal oxygen saturation at rest and during exercise. Maximum workload increased from 7.2 (1.9) to 9.0 (2.2) metabolic equivalents (p < 0.001).

Conclusions: Percutaneous closure of interatrial communications associated with a right to left shunt allows restoration of normal oxygen saturation at rest, avoidance of desaturation during exercise, and improvement of exercise performance in patients with CHD.

  • ASD, atrial septal defect
  • CHD, congenital heart disease
  • METs, metabolic equivalents
  • PFO, persistent foramen ovale
  • cardiac catheterisation
  • atrial septal defect
  • persistent foramen ovale
  • cyanosis

Statistics from Altmetric.com

Footnotes

  • Published Online First 3 November 2005

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.