Cardiopulmonary response to exercise in patients with intrapulmonary vascular shunts

M. K.B. Whyte, J. M.B. Hughes, J. E. Jackson, A. M. Peters, S. C. Hempleman, D. P. Moore, H. A. Jones

Research output: Contribution to journalArticle

37 Scopus citations

Abstract

The majority of patients with intrapulmonary right-to-left shunting due to pulmonary arteriovenous malformations exhibit good maximum exercise capacity (>70% predicted) despite profound arterial oxygen desaturation. We studied seven such patients to assess tissue oxygen delivery during steady-state exercise. From rest to exercise [50 ± 7 (SE) W] arterial saturation fell from 80 ± 3 to 74 ± 3%, and mean right-to-left shunt increased slightly from 31 ± 4 to 34 ± 5% (P = NS). Minute ventilation was high for oxygen uptake, and the ventilatory equivalent was raised (174 ± 19% predicted) and was correlated with shunt size (r = 0.93). The majority of the patients maintained pulmonary alveolar blood flow within the predicted range for their power output, but total cardiac output was increased to 142 ± 11% predicted due to flow through the shunt. Consequently, on exercise, oxygen delivery per unit oxygen consumption [2.3-3.3 (normal range 1.6-2.4)] and calculated mixed venous oxygen tension (27.0 ± 0.8 Torr) were preserved. Arterial PCO2 rose on exercise by 2.8 ± 1.2 Torr, in proportion to the ratio of flow through the shunt to total cardiac output (r = 0.73), but remained low (33.1 ± 1.4 Torr) in absolute terms. The high cardiac output on exercise may be facilitated by a low pulmonary vascular resistance (0.33 ± 0.08 mmHg · l- 1 · min, measured at rest), which may explain why exercise performance is better in these patients than in patients with equivalent hypoxemia from other causes.

Original languageEnglish (US)
Pages (from-to)321-328
Number of pages8
JournalJournal of Applied Physiology
Volume75
Issue number1
DOIs
StatePublished - 1993
Externally publishedYes

Keywords

  • exercise hypoxemia
  • pulmonary arteriovenous malformations
  • right-to-left shunt

ASJC Scopus subject areas

  • Physiology
  • Physiology (medical)

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    Whyte, M. K. B., Hughes, J. M. B., Jackson, J. E., Peters, A. M., Hempleman, S. C., Moore, D. P., & Jones, H. A. (1993). Cardiopulmonary response to exercise in patients with intrapulmonary vascular shunts. Journal of Applied Physiology, 75(1), 321-328. https://doi.org/10.1152/jappl.1993.75.1.321