Postoperative assessment of patients with ventricular septal defect and pulmonary hypertension. Response to intense upright exercise.

Abstract

Circulatory function of patients with operatively closed ventricular septal defect and preoperative pulmonary arterial hypertension was evaluated in 11 asymptomatic subjects at rest and during intense treadmill exercise three to 15 years after operation. The pulmonary-to-systemic resistance ratio was normal or mildly to moderately elevated preoperatively. Postoperative mean pulmonary arterial pressure at the time of study was normal or mildly elevated at rest in 10 patients and moderately elevated in one (40 mm Hg). During intense upright exercise sufficient to lower pulmonary arterial oxygen saturation to 30%, cardiac output was below the normal range in five patients. Each of these patients had been operated upon after 10 years of age. The magnitude of the postoperative abnormality in cardiac output response to exercise was directly related to age at operation. Two of the five patients with impaired cardiac output response and two other patients manifested an abnormally elevated mean pulmonary arterial pressure during intense exercise. There was a positive correlation between pulmonary arterial pressure during intense exercise and age at operation. These results indicate that late postoperative cardiovascular function may be abnormal in patients with ventricular septal defect and preoperative pulmonary arterial hypertension, and that these abnormalities appear to be related to age at operation. Since all patients were asymptomatic, the long-term clinical significance of these hemodynamic abnormalities remains to be determined.