@Article{chd.12665,
AUTHOR = {Martina Nassif, Reindert P. van Steenwijk, Jacqueline M. Hogenhout, Huangling Lu, Rianne H.A.C.M. de Bruin‐Bon B Health, Alexander 
Hirsch, Peter J. Sterk MD, PhD2 | Berto J. Bouma MD, PhD1 | Bart Straver 
MD, PhD4 | Jan G.P. Tijssen, Barbara J.M. Mulder, Robbert J. de 
Winter},
TITLE = {Atrial septal defect in adults is associated with airway hyperresponsiveness},
JOURNAL = {Structural and Congenital Heart Disease},
VOLUME = {13},
YEAR = {2018},
NUMBER = {6},
PAGES = {959--966},
URL = {http://www.techscience.com/schd/v13n6/39077},
ISSN = {3071-1738},
ABSTRACT = {<b>Objective:</b> 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.<br/>
<b>Methods:</b> 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.<br/>
<b>Results:</b> 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.<br/>
<b>Conclusions:</b> 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.},
DOI = {10.1111/chd.12665}
}