A Combined Outpatient and Home-Based Rehabilitation Program for a Patient with an Open Atrial Septal Defect (ASD) and Severe Pulmonary Hypertension: A Case Report
Keywords:atrial septal defect, dyspnea, exercise, fatigue, pulmonary hypertension
Objectives: This paper presents a rehabilitation intervention for improving functional capacity and physical activity level in a patient with an open atrial septal defect (ASD) with severe pulmonary hypertension contraindicated to ASD closure.
Study design: Case report.
Setting: Hasan Sadikin General Hospital, Bandung, West Java, Indonesia.
Subjects: A-37 year old female, an elementary school teacher, complained of shortness of breath when doing daily activities, walking, and speaking for three years. She was planned for ASD closure but could not be done because of severe pulmonary hypertension. The right heart catheterization showed pulmonary hypertension (mean Pap: 70 mmHg). In addition, the CT-Scan showed cardiomegaly with pulmonary hypertension and pulmonary fibrosis.
Methods: A combined outpatient and home-based comprehensive rehabilitation program including cardiopulmonary endurance exercise with a treadmill, breathing exercises (controlled breathing and deep breathing), and sustained maximum inspiration technique were prescribed to reduce fatigue and dyspnea on exertion.
Results: Eight weeks after following the program, there were improvements in cardiorespiratory fitness (from 2.92 to 5.27 METs), maximum inspiratory volume (from 1,500 to 2,500 ml), the Modified Medical Research Council (MMRC) scale (from 2 to 1), and the Fatigue Severity Scale (FSS) (from 71 % to 45 %).
Conclusions: In a limited inpatient rehabilitation service country like Indonesia, a combined outpatient and home-based rehabilitation program of exercises benefits the functional capacity of a patient with an open ASD with severe pulmonary hypertension and mild pulmonary fibrosis.
Keywords: atrial septal defect, dyspnea, exercise, fatigue, pulmonary hypertension
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