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


  • Sunaryo Barki Sastradimaja
  • Arya Resident of Physical Medicine and Rehabilitation of Padjadjaran University
  • Vitriana Biben
  • Tertianto Prabowo


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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Forlemu AN, Ajmal M, Saririan M. Atrial septal defect with Eisenmenger syndrome: a rare presentation. Case Rep Cardiol [Internet]. 2020 Mar 9 [cited 2021 Jan 05]. 2020:1-4. Available from: https//doi.org/10.1155/2020/8681761

Nashat H, Montanaro C, Li W, Kempny A, Wort SJ, Dimopoulos K, et al. Atrial septal defects and pulmonary arterial hypertension. J Thorac Dis. 2018;10:S2953-65.

Supomo S, Hartopo AB, Anggrahini DW, Darmawan H, Dinarti LK. Large atrial septal defect closure in a patient with severe pulmonary arterial hypertension. Korean J Thorac Cardiovasc Surg. 2017;50:378-81.

Zhang X, Xu D. Effects of exercise rehabilitation training on patients with pulmonary hypertension. Pulm Circ. 2020;10:1-8.

Grünig E, Eichstaedt C, Barberà JA, Benjamin N, Blanco I, Bossone E, et al. ERS statement on exercise training and rehabilitation in patients with severe chronic pulmonary hypertension. Eur Respir J. 2019;53:1-28.

Morris JH, Chen L. Exercise training and heart failure: a review of the literature. Card Fail Rev. 2019;5:57-61.

Valko PO, Bassetti CL, Bloch KE, Held U, Baumann CR. Fatigue Severity Scale (FSS, English version). Sleep. 2008;11:1601-7.

Ubolnuar N, Tantisuwat A, Thaveeratitham P, Lertmaharit S, Kruapanich C, Mathiyakom W. Effects of breathing exercises in patients with chronic obstructive pulmonary disease: systematic review and meta-analysis. Ann Rehabil Med. 2019;43:509-23.

Sahni S, Capozzi B, Iftikhar A, Sgouras V, Ojrzanowski M, Talwar A. Pulmonary rehabilitation and exercise in pulmonary arterial hypertension: an underutilized intervention. J Exerc Rehabil. 2015; 11:74-9.

Gayathiri T, Anandhi D. Efficacy of incentive spirometry in expiratory muscle training following abdominal surgery. Biomed Pharmacol J. 2021;14:335-41.

Roldán A, Monteagudo P, Cordellat A, Sanchis-Soler G, Blasco-Lafarga C. Inspiratory muscle strength and cardiorespiratory fitness association with health-related quality of life in healthy older adults. Front Sport Act Living. 2021;3:1-9.

Molgat-Seon Y, Dominelli PB, Ramsook AH, Schaeffer MR, Sereacki SM, Foster GE, et al. The effects of age and sex on mechanical ventilatory constraint and dyspnea during exercise in healthy humans. J Appl Physiol. 2018;124:1092-106.

Yang YJ. An overview of current physical activity recommendations in primary care. Korean J Fam Med. 2019;40:135-42.

Crisafulli E, Clini EM. Measures of dyspnea in pulmonary rehabilitation. Multidiscip Respir Med. 2010;5:202-10.

Chan L, Chin LMK, Kennedy M, Woolstenhulme JG, Nathan SD, Weinstein AA, et al. Benefits of intensive treadmill exercise training on cardiorespiratory function and quality of life in patients with pulmonary hypertension. Chest. 2013;143:333-43.

Hillegass E, Fick A, Pawlik A, Crouch R, Perme C, Chandrashekar R, et al. Supplemental oxygen utilization during physical therapy interventions. Cardiopulm Phys Ther J. 2014;25:38-49.