{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,13]],"date-time":"2025-05-13T21:57:58Z","timestamp":1747173478718,"version":"3.40.5"},"reference-count":29,"publisher":"Cambridge University Press (CUP)","issue":"10","license":[{"start":{"date-parts":[[2022,12,5]],"date-time":"2022-12-05T00:00:00Z","timestamp":1670198400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Cardiol Young"],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S1047951122003742_as1\"><jats:title>Objectives:<\/jats:title><jats:p>Small, unrepaired atrial septal defects are considered a benign lesion with good prognosis. Recently, clinical and register-based studies discovered increased long-term mortality and morbidity. The nature of these findings is not fully understood. Therefore, MRI was performed to evaluate cardiac function at rest and during exercise.<\/jats:p><\/jats:sec><jats:sec id=\"S1047951122003742_as2\"><jats:title>Methods:<\/jats:title><jats:p>Adults with open or spontaneously closed atrial septal defects and healthy, matched controls underwent MRI for evaluation of cardiac chamber volume. Quantitative flow scans measured blood flow in the ascending aorta and the proximal pulmonary artery at rest and during increasing supine exercise.<\/jats:p><\/jats:sec><jats:sec id=\"S1047951122003742_as3\"><jats:title>Results:<\/jats:title><jats:p>In total, 15 open defects (39 \u00b1 11 years) and 15 matched controls (38 \u00b1 12 years) were included, along with 20 spontaneously closed (36 \u00b1 13 years) and 20 controls (36 \u00b1 11 years). Cardiac chamber volumes and flow measurements at rest were comparable between groups, as were heart rates and workloads during exercise. At maximal exercise, open defects reached 31% lower cardiac index and had 38% higher retrograde flow in the pulmonary artery than their controls, p &lt; 0.01. Shunt ratio remained unchanged during exercise, 1.2 \u00b1 0.2. Closed defects reached 18% lower cardiac index, p = 0.02, with comparable pulmonary retrograde flow. Maximal cardiac index was inversely correlated with increasing age for patients only.<\/jats:p><\/jats:sec><jats:sec id=\"S1047951122003742_as4\"><jats:title>Conclusion:<\/jats:title><jats:p>Adults with a small, open or spontaneously closed atrial septal defects exhibit markedly lower exercise capacity compared with healthy peers. Moreover, open defects exhibit higher retrograde flows with increasing exercise. Finally, increasing age is related to poorer results in patients but not healthy controls. Longitudinal studies are necessary in order to determine potential accelerated worsening of physical capacity along with age-related changes in patients.<\/jats:p><\/jats:sec>","DOI":"10.1017\/s1047951122003742","type":"journal-article","created":{"date-parts":[[2022,12,5]],"date-time":"2022-12-05T09:36:30Z","timestamp":1670232990000},"page":"1981-1991","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":1,"title":["Adults with small, unrepaired atrial septal defects have reduced cardiac index during 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