Open Access

ARTICLE

Atrial septal defect in adults is associated with airway hyperresponsiveness

Martina Nassif¹, Reindert P. van Steenwijk², Jacqueline M. Hogenhout², Huangling Lu¹, Rianne H.A.C.M. de Bruin‐Bon B Health¹, Alexander Hirsch^1,3, Peter J. Sterk MD, PhD2 | Berto J. Bouma MD, PhD1 | Bart Straver MD, PhD4 | Jan G.P. Tijssen¹, Barbara J.M. Mulder^1,5, Robbert J. de Winter¹

1 Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
2 Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands
3 Department of Cardiology and Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
4 Department of Pediatric Cardiology, Academic Medical Center, Amsterdam, The Netherlands
5 Netherlands Heart Institute, Utrecht, The Netherlands

* Corresponding Author: Robbert J. de Winter, MD PhD FESC, Academic Medical Center‐ University of Amsterdam, Department of Cardiology, Room B2‐137, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. Email:

Congenital Heart Disease 2018, 13(6), 959-966. https://doi.org/10.1111/chd.12665

Abstract

Objective: The association between secundum atrial septal defects (ASD) and asthma‐ like dyspnea with consequent long‐term pulmonary inhalant use, is poorly understood in adult ASD patients. Airway hyperresponsiveness is suggested to be the underlying mechanism of cardiac asthma from mitral valve disease and ischemic cardiomyopathy. We hypothesized that airway hyperresponsiveness may also be found in adult ASD patients. Our aim was to study airway responsiveness in adult ASD patients before percutaneous closure and at short‐and long‐term postprocedural follow‐up.
Methods: This prospective study included 31 ASD patients (65% female, mean age 49 ± 15y) who underwent spirometry and bronchoprovocation testing pre‐and six‐ month postprocedurally, with additional bronchoprovocation at 2‐year follow‐up. Airway hyperresponsiveness was defined as ≥20% fall of forced expiratory volume in 1‐second (FEV1) following <8.0 mg/mL of inhaled methacholine.
Results: Airway hyperresponsiveness was found in 19/30 patients (63%[95%CI 45%‐81%]; post hoc statistical power = 89%). Asthma‐like symptoms wheezing, chest tightness, and cough were more frequently reported in airway hyperresponsive pa‐ tients. Airway responsiveness was not influenced by successful percutaneous ASD closure, corresponding to persistence of asthma‐like symptoms postclosure. Regardless of airway responsiveness, postprocedural right‐sided reverse remodeling significantly improved dyspnea and pulmonary function.
Conclusions: This study is the firsttoreport ahighprevalenceof airwayhyperresponsiveness in a cohort of unrepaired adult ASD patients, and confirms the association between asthma‐ like symptoms and ASD in adults. Attention to symptoms and pulmonary function should be given during clinical follow‐up of adult ASD patients, both before and long afterrepair.

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