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Lung function in VSD patients after corrective heart surgery
J Sulc1, M Samánek, A Zapletal
1Kardiocentrum, University Hospital Motol, Prague, Czech Republic.
Insights
Children undergoing surgery for ventricular septal defect (VSD) experience altered lung function, including reduced airway patency. Lung function tests reveal significant changes post-surgery, with correlations to pulmonary artery pressure.
Area of Science:
- Pediatric Cardiology
- Pulmonary Medicine
- Thoracic Surgery
Background:
- Ventricular septal defect (VSD) is a common congenital heart disease requiring surgical intervention.
- Surgical repair of VSD can impact respiratory system mechanics and lung function.
- Understanding post-operative pulmonary function is crucial for long-term patient outcomes.
Purpose of the Study:
- To assess static lung volumes, lung elasticity, and airway patency in children following VSD surgery.
- To compare lung function between children with primary VSD repair and those with prior pulmonary artery banding.
- To investigate correlations between lung function parameters and pre-operative pulmonary artery pressure.
Main Methods:
- Pulmonary function tests including static lung volumes, lung elasticity, and airway patency indices were performed.
- 47 children operated on for VSD were divided into two groups: primary repair and prior pulmonary artery banding.
- Correlation analysis was used to examine relationships between lung function and mean pulmonary artery pressure (mPAP).
Main Results:
- Children with primary VSD repair showed increased lung recoil pressure and reduced specific airway conductance (sGaw).
- Children with prior pulmonary artery banding exhibited increased functional residual capacity/TLC ratio, reduced sGaw, and reduced maximum expiratory flow.
- Lung volumes were insignificantly reduced in both groups; lung function disturbances were frequent (71-77%).
- A positive correlation was found between sGaw and mPAP (<30 mmHg), and between static recoil pressure and mPAP (>30 mmHg).
Conclusions:
- VSD surgery significantly alters lung function, particularly airway patency and elasticity.
- The timing and type of surgical intervention (primary repair vs. prior banding) may influence post-operative lung function.
- Pre-operative pulmonary artery pressure is correlated with specific lung function parameters, suggesting its role in post-operative respiratory outcomes.
Abstract:
Static lung volumes, lung elasticity, and airway patency indices were measured in 47 children operated on for ventricular septal defect (VSD). Open-heart surgery was performed at the age of 0.6-12.0 years (median 4.1 years). In the first group (34 subjects), after primary repair of the VSD, there was an increase in lung recoil pressure at 100% of total lung capacity (TLC) (128% of the predicted value) and a reduction in specific airway conductance (sGaw) (75% of the predicted value). In the second group (13 patients), who had had previous pulmonary artery banding at 0.2-4.0 years (median 0.7 year) there was an increased functional residual capacity/TLC ratio (111% of predicted value), reduced sGaw (69% of predicted value), and reduced maximum expiratory flow at 25% of vital capacity (79% of predicted value). Lung volumes were insignificantly reduced in both groups. The frequency of lung function disturbances was similar in the two groups (71% of patients in the former group and 77% of patients in the latter group). A linear positive correlation between specific airway conductance and the mean pulmonary artery pressure (mPAP) (r = 0.793, p < 0.006) was observed in children with an mPAP <30 mmHg prior to open-heart surgery. A positive correlation between static recoil pressure at full inflation and mPAP (r = 0.545, p < 0.03) was found in children with an mPAP > 30 mmHg. The severity of congenital heart disease prior to surgery and the influence of the timing of the surgical procedures may cause the differences in lung function tests between the groups.