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Pulmonary vascular resistance in ventricular septal defects. The long-term prognosis as evaluated by the
Insights
Children with ventricular septal defects and high pulmonary vascular resistance (PVR) face poor prognoses. Sequential PVR measurements using thermodilution can identify reactive pulmonary vascular beds, indicating a better outlook for these young patients.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Physiology
- Medical Engineering
Background:
- Ventricular septal defects (VSDs) can lead to pulmonary hypertension.
- Pulmonary vascular resistance (PVR) is a critical indicator of VSD severity and prognosis.
- Accurate PVR measurement is essential for guiding treatment decisions in pediatric VSD patients.
Purpose of the Study:
- To investigate the utility of the thermodilution method for determining pulmonary blood flow and calculating PVR in young children with VSDs.
- To assess the prognostic value of sequential PVR measurements in this cohort.
- To differentiate between reactive and non-reactive pulmonary vascular beds in high-PVR VSD patients.
Main Methods:
- Thermodilution method used to measure pulmonary blood flow.
- Calculation of pulmonary vascular resistance (PVR) in 26 children with VSDs (age < 2 years).
- Sequential PVR monitoring in 14 patients, particularly those with elevated PVR.
Main Results:
- Eleven children had PVR ≥ 3 units; 6 died (4 intraoperatively, 2 preoperatively).
- Fifteen children had PVR < 3 units; 2 died, with no long-term complications.
- Sequential PVR measurements in the high-resistance group distinguished between patients with poor prognosis and those with a reactive pulmonary vascular bed and good prognosis.
Conclusions:
- Thermodilution is a valuable tool for assessing PVR in infants and young children with VSDs.
- Elevated PVR in VSD patients is associated with increased mortality.
- Sequential PVR monitoring aids in risk stratification and predicting outcomes in pediatric VSDs.
Abstract:
Twenty-six children with ventricular septal defects were investigated using the thermodilution method for determining pulmonary blood flow and calculating pulmonary vascular resistance (PVR). Fourteen were followed sequentially. All were below 2 years of age at the first investigation. Eleven of them had a PVR of three units or more. Six of the children in this group died; four at operation, two before operation. One has a residual shunt and equilibrated pressures. Fifteen patients had a PVR below three units; two of them died, none had any long-term complications. In the high-resistance group, sequential determinations of PVR with the thermodilution method further helped to separate those with a poor prognosis from those whose pulmonary vascular bed was still reactive and for whom prognosis was good.