{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T11:49:57Z","timestamp":1753876197981,"version":"3.41.2"},"reference-count":27,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2019,10,18]],"date-time":"2019-10-18T00:00:00Z","timestamp":1571356800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100007605","name":"Aarhus University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007605","id-type":"DOI","asserted-by":"publisher"}]},{"name":"L\u00e6geforeningens Forskningsfond"},{"name":"Snedkermester Sophus Jacobsen & Hustru Astrid Jacobsen\u2019s Fund"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p\/>\n               <jats:sec>\n                  <jats:title>OBJECTIVES<\/jats:title>\n                  <jats:p>Small ventricular septal defects are often considered to be without long-term haemodynamic consequences and so the majority remains unrepaired. However, we recently showed reduced functional capacity and altered right ventricular morphology in adults with small, unrepaired ventricular septal defects. The underlying mechanisms behind these findings remain unclear, and so, biventricular contractility during exercise was evaluated.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>Adults with small, unrepaired ventricular septal defects and healthy controls were examined with echocardiography during supine bicycle exercise with increasing workload. Tissue velocity Doppler was used for evaluating isovolumetric acceleration and systolic velocities during exercise.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>In total, 34 patients with ventricular septal defects, a median shunt- ratio of 1.2 (26\u2009\u00b1\u20096\u2009years), and 28 healthy peers (27\u2009\u00b1\u20095\u2009years) were included. Right ventricular isovolumetric acceleration was lower in patients as compared with controls at rest (97\u2009\u00b1\u200940 vs 158\u2009\u00b1\u200943\u2009cm\/s2, P\u2009=\u20090.01) and at peak heart rate (222\u2009\u00b1\u2009115 vs 410\u2009\u00b1\u2009120\u2009cm\/s2, P\u2009&lt;\u20090.01). Peak systolic velocities were similar at rest, but differed with exercise (13\u2009\u00b1\u20093 vs 16\u2009\u00b1\u20093\u2009cm\/s, P\u2009=\u20090.02). Left ventricular isovolumetric acceleration was lower in patients as compared with controls throughout the test (P &lt; 0.01). Septal isovolumetric acceleration was similar at rest, but reduced during increasing exercise as compared with controls (220\u2009\u00b1\u2009108 vs 303\u2009\u00b1\u2009119\u2009cm\/s2, P\u2009=\u20090.03). Left ventricular isovolumetric acceleration was negatively correlated with the shunt- ratio, and right ventricular and septal peak systolic velocities were positively correlated with lower functional capacity.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>Altered biventricular contractility is present during exercise in adults with small, unrepaired ventricular septal defects. These results add to the growing number of studies showing that long-term outcome in unrepaired ventricular septal defects may not be benign.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ejcts\/ezz278","type":"journal-article","created":{"date-parts":[[2019,10,8]],"date-time":"2019-10-08T08:10:13Z","timestamp":1570522213000},"source":"Crossref","is-referenced-by-count":1,"title":["Reduced biventricular contractility during exercise in adults with small, unrepaired ventricular septal defects: an echocardiographic study"],"prefix":"10.1093","author":[{"given":"Marie","family":"Maagaard","sequence":"first","affiliation":[{"name":"Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark"},{"name":"Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johan","family":"Heiberg","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark"},{"name":"Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew N","family":"Redington","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Heart Institute, Cincinnati Children\u2019s Hospital, Cincinnati, OH, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vibeke E","family":"Hjortdal","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark"},{"name":"Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2019,10,18]]},"reference":[{"key":"2019101806290548400_ezz278-B1","doi-asserted-by":"crossref","first-page":"2725","DOI":"10.1016\/j.jacc.2017.03.587","article-title":"Interventional treatment of patients with congenital heart disease: nationwide Danish experience over 39 years","volume":"69","author":"Larsen","year":"2017","journal-title":"J Am Coll Cardiol"},{"key":"2019101806290548400_ezz278-B2","doi-asserted-by":"crossref","first-page":"1170","DOI":"10.1016\/S0735-1097(01)01272-4","article-title":"Task force 1: the changing profile of congenital heart disease in adult life","volume":"37","author":"Warnes","year":"2001","journal-title":"J Am Coll Cardiol"},{"key":"2019101806290548400_ezz278-B3","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1055\/s-2001-9918","article-title":"Care of adults with congenital heart disease: a challenge for the new millennium","volume":"49","author":"Webb","year":"2001","journal-title":"Thorac Cardiovasc Surg"},{"key":"2019101806290548400_ezz278-B4","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1016\/j.ijcard.2016.01.208","article-title":"Clinical course and potential complications of small ventricular septal defects in adulthood: late development of left ventricular dysfunction justifies lifelong care","volume":"208","author":"Karonis","year":"2016","journal-title":"Int J Cardiol"},{"key":"2019101806290548400_ezz278-B5","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1016\/j.amjcard.2009.09.047","article-title":"Behavior of unrepaired perimembranous ventricular septal defect in young adults","volume":"105","author":"Soufflet","year":"2010","journal-title":"Am J Cardiol"},{"key":"2019101806290548400_ezz278-B6","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1111\/j.1365-2796.1990.tb00237.x","article-title":"Long-term follow-up in isolated ventricular septal defect considered too small to warrant operation","volume":"228","author":"Otterstad","year":"1990","journal-title":"J Intern Med"},{"key":"2019101806290548400_ezz278-B7","doi-asserted-by":"crossref","first-page":"1573","DOI":"10.1053\/euhj.1998.1083","article-title":"Small ventricular septal defects in adults","volume":"19","author":"Neumayer","year":"1998","journal-title":"Eur Heart J"},{"key":"2019101806290548400_ezz278-B8","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1159\/000448513","article-title":"Long-term outcome of patients with perimembranous ventricular septal defect: results from the Belgian registry on adult congenital heart disease","volume":"136","author":"Gabriels","year":"2017","journal-title":"Cardiology"},{"key":"2019101806290548400_ezz278-B9","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1016\/j.ijcard.2016.10.086","article-title":"Small, unrepaired ventricular septal defects reveal poor exercise capacity compared with healthy peers: a prospective, cohort study","volume":"227","author":"Maagaard","year":"2017","journal-title":"Int J Cardiol"},{"key":"2019101806290548400_ezz278-B10","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1093\/ejcts\/ezw420","article-title":"Does functional capacity depend on the size of the shunt? 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