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The operability of patient with pulmonary hypertension judged from hemodynamic changes before and after surgery
Insights
Surgical correction is viable for congenital heart disease with pulmonary hypertension and a low right-to-left shunt ratio. Early surgical intervention in pediatric patients with pulmonary hypertension and mitral valve disease is recommended.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Cardiovascular Surgery
Background:
- Pulmonary hypertension (PH) in congenital heart disease (CHD) presents complex management challenges.
- Surgical intervention timing and indications in pediatric cardiovascular conditions require careful consideration.
- Mitral valvular disease (MVD) can coexist with or contribute to PH.
Purpose of the Study:
- To define the role of surgical correction in CHD with PH.
- To evaluate the impact of age on surgical outcomes in pediatric PH.
- To establish criteria for surgical intervention in MVD with PH.
Main Methods:
- Analysis of lung scintigraphy to determine right-to-left (R to L) shunt ratios in CHD with PH.
- Comparative analysis of surgical outcomes based on patient age.
- Assessment of preoperative U/L ratios in patients with MVD and PH.
Main Results:
- Surgical correction remains an option for CHD with PH and an R to L shunt ratio < 25%, even with near-systemic pulmonary artery (PA) pressure.
- Patients younger than 3 years with PH in CHD show greater surgical acceptance.
- Surgical correction is indicated for MVD with PH if preoperative U/L ratios are < 2.4.
Conclusions:
- Surgical intervention is feasible and beneficial in select CHD with PH patients based on shunt fraction.
- Early surgical management is advantageous for pediatric patients with PH.
- Preoperative U/L ratio is a critical factor in surgical decision-making for MVD with PH.
Abstract:
1) In congenital heart disease with pulmonary hypertension, the place for surgical correction still remains even with almost systemic PA pressure if R to L shunt ratio on lung scintigram is lower than 25%. 2) The patient with pulmonary hypertension in congenital heart disease younger than 3 years of age has wider acceptability for surgery compared to older patient. 3) In patients with mitral valvular disease, surgical correction seems to be indicated irrespective of PA pressure, if their preoperative U/L are lower than 2.4.