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[Pulmonary hypertensive crisis after open heart surgery]
Kyobu Geka. the Japanese Journal of Thoracic Surgery
|April 1, 1989
Summary
Pulmonary hypertensive crisis (PHC) after heart surgery can occur in young children. Prostaglandin-E1 effectively treated PHC, and continuous monitoring helped distinguish it from heart failure.
Area of Science:
- Cardiology
- Pediatric Surgery
- Pulmonary Hypertension
Background:
- Ventricular septal defect (VSD) repair is a common pediatric cardiac surgery.
- Pulmonary hypertensive crisis (PHC) is a rare but serious complication post-VSD repair.
- Pulmonary vascular obstructive disease (PVOD) is a known risk factor for PHC.
Observation:
- Three pediatric patients (2-47 months) developed PHC after VSD repair.
- Intraoperative lung biopsy revealed Health-Edwards grade 2 PVOD in all patients.
- Chest X-rays showed atelectasis or pleural effusion during PHC episodes.
Findings:
- Continuous monitoring of arterial blood pressure (ABP), pulmonary artery pressure (PAP), and left atrial pressure (LAP) aided diagnosis.
- Prostaglandin-E1 administered via pulmonary artery catheter proved effective in managing PHC.
- Hemodynamic monitoring helped differentiate PHC from acute left or right heart failure.
Implications:
- Early recognition and management of PHC are crucial in pediatric cardiac surgery patients.
- Prostaglandin-E1 is a viable treatment option for PHC post-VSD repair.
- Continuous hemodynamic monitoring is valuable for diagnosing and managing cardiovascular complications after pediatric heart surgery.