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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}


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

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  • Published Online First 3 November 2005