I am a 20 year old female college student who swam for my college team up until the time(Mar 2011) when i felt very short of breath and had other symptoms like chest pain. They found that my oxygen saturation was 75% when moving(positional) and that i had an 8.5 mm hole between the 2 atria of my heart (ASD/PFO) with right to left shunting. It was repaired with an amplatzer device and my saturation returned to 100%. I was told it was fine to return to swim and that my lungs/heart were normal. When i returned and trained for a while, i still had some shortness of breath with extreme exercise like racing. (I am a very fit, 5'4'' and 110 lbs) I had a pulmonary function test in Dec. 2011 and everything turned out normal except my Dlco was 70% and my DLVA was 78%. I was told i probably have early pulmonary hypertension or early cardiopulmonary vascular disease. When they did my heart repair(April 2011), my right ventricular pressure was 22, a pulmonary artery pressure of 20/10 with a mean of 14 which i was told that 25 is considered PH. this was before the hole was closed and the pressures have not been rechecked by catheterization after. Nov. 2011, I did have a exercise echo and had a right ventricular pressure of 23. I did a cardiopulmonary exercise test a few days ago and it came out completely normal. They only found that i have vocal cord dysfunction so that explains why i am not able to breathe as well when i get into intense exercise. I repeated the PFT and the diffusion came out to 68%. A different doctor says that this may be "normal" for my body and that i have no lung/heart disease based on the CPET. I just feel uncomfortable that my dlco is lower than normal and the two different pulmonary doctors do not agree. I am wondering if all my symptoms could be very early signs of PH or that maybe i have exercise induced PH. i just was wondering what your opinion was and whether you have ever heard of someone having a normal diffusion of 68-70%.
Concerning the DLCO of 70%, this is a complex issue, based on a test that requires rigorous adherence to every aspect of the test protocol. This being the case, a seemingly reduced value can be reflective of pulmonary disease or a flawed testing procedure. The Mason Textbook of Pulmonary Disease contains a very detailed discussion of the DLCO. The following is from that discussion.
Clinical Utility of Diffusing Capacity From Mason Textbook of Pulmonary Disease The main objective of pulmonary function testing is to provide useful information to help answer the clinical question for which the test was ordered. Diffusing capacity interpretation is most clinically useful when it is performed in conjunction with measurements of spirometry and lung volumes. A low DlCO with normal spirometry suggests the presence of pulmonary vascular disease, early interstitial lung disease, emphysema associated with a restrictive lung process, anemia (reduced hemoglobin), or elevated carboxyhemoglobin level. Pulmonary vascular diseases such as idiopathic pulmonary artery hypertension, pulmonary embolism, chronic thromboembolic pulmonary hypertension, and pulmonary vasculitis should be considered in a patient with a significant reduction in DlCO and normal spirometry and lung volumes.,
I suggest that you ask your pulmonologist to review the above textbook material and ask if it applies to your case. You might also request that he/she the entire discussion of the that section in the textbook on the DLCO to determine if any of the causes for invalid results might be applicable to your situation. Should such a discussion or review be deemed by your pulmonologist to not be feasible, my next suggestion is that you request referral to an academically based pulmonologist, with expertise in all aspects of lung physiology and able to interpret your DLCO of 70% and its cause.
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