Alternative approach for selected severe pulmonary hypertension of congenital heart defect without initial correction — Palliative surgical treatment

Lin, Min; Chen, Yih‐Sharng; Huang, Shu‐Chien; Chiu, H. H.; Chiu, Shuenn–Nan; Wu, En‐Ting; Chiu, Ing Sh; Chang, Chung-I; Wu, Mei; Wang, Jou‐Kou

doi:10.1016/j.ijcard.2010.05.067

Cited by 12 publications

(5 citation statements)

References 14 publications

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“…490 PVD, even in the presence of advanced structural remodeling, may regress after banding, 491,492 but pulmonary artery banding in patients with an increased PVRI has not found a routine place in therapy. 493,494 Respiratory management plays a critical role in the management of PH and avoidance of PHCs. Maintaining adequate lung volumes (functional residual capacity) and gas exchange while avoiding acidosis during the postoperative period is crucial for successful outcomes.…”

Section: Treatment Of Postoperative Phmentioning

confidence: 99%

Pediatric Pulmonary Hypertension

Abman¹,

Hansmann²,

Archer³

et al. 2015

Circulation

916

405

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Abstract-Pulmonary hypertension is associated with diverse cardiac, pulmonary, and systemic diseases in neonates, infants, and older children and contributes to significant morbidity and mortality. However, current approaches to caring for pediatric patients with pulmonary hypertension have been limited by the lack of consensus guidelines from experts in the field. In a joint effort from the American Heart Association and American Thoracic Society, a panel of experienced clinicians and clinician-scientists was assembled to review the current literature and to make recommendations on the diagnosis, evaluation, and treatment of pediatric pulmonary hypertension. This publication presents the results of extensive literature reviews, discussions, and formal scoring of recommendations for the care of children with pulmonary hypertension. Key Words: AHA Scientific Statements ◼ bronchopulmonary dysplasia ◼ congenital diaphragmatic hernia ◼ congenital heart disease ◼ genetics ◼ persistent pulmonary hypertension of the newborn ◼ sickle cell disease © 2015 by the American Heart Association, Inc., and the American Thoracic Society.Circulation is available at http://circ.ahajournals.org DOI: 10.1161/CIR.0000000000000329 †Deceased. The American Heart Association and the American Thoracic Society make every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.This document was approved by the American Heart Association Science Advisory and Coordinating Committee on May 12, 2015, the American Heart Association Executive Committee on July 22, 2015, and the American Thoracic Society on July 24, 2015.The online-only Data Supplement is available with this article at http://circ.ahajournals.org/lookup/suppl/doi:10.1161/CIR.0000000000000329/-/DC1. The American Heart Association requests that this document be cited as follows: Abman SH, Hansmann G, Archer SL, Ivy DD, Adatia I, Chung WK, Hanna BD, Rosenzweig EB, Raj JU, Cornfield D, Stenmark KR, Steinhorn R, Thébaud B, Fineman JR, Kuehne T, Feinstein JA, Friedberg MK, Earing M, Barst RJ, Keller RL, Kinsella JP, Mullen M, Deterding R, Kulik T, Mallory G, Humpl T, Wessel DL; on behalf of the American Heart Association Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation, Council on Clinical Cardiology, Council on Cardiovascular Disease in the Young, Council on Cardiovascular Radiology and Intervention, Council on Cardiovascular Surgery and Anesthesia, and the American Thoracic Society. Pediatric pulmonary hypertension: guidelines from the American Heart Association and American Thoracic Society. Circulation. 2015;132:2037-2099 Copies: This document is available on the World Wide Web site of the American Heart Associat...

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Section: Treatment Of Postoperative Phmentioning

confidence: 99%

Pediatric Pulmonary Hypertension

Abman¹,

Hansmann²,

Archer³

et al. 2015

Circulation

916

405

View full text Add to dashboard Cite

show abstract

“…Interventional therapies for subsets of ES and other severe PAH-CHD have been reported: pulmonary artery banding, 57,58 atrial baffle placement to optimize streaming of oxygenated blood, 59 and targeted medical therapy followed by subsequent shunt closure. 60 Reported acute and short-term results of such interventions at experienced centers are hopeful, but the long-term consequences remain unknown.…”

Section: Medical and Interventional Approaches To Pulmonary Vascular mentioning

confidence: 99%

Clinical Evaluation and Management of Pulmonary Hypertension in the Adult With Congenital Heart Disease

Opotowsky

2015

Circulation

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200P ulmonary hypertension (PH) refers to elevated pulmonary artery (PA) pressure (PAP), defined as mean PAP≥25 mm Hg. PH is not synonymous with pulmonary arterial hypertension (PAH), which specifies resistive PH characterized by elevated pulmonary vascular resistance (PVR) and normal pulmonary venous pressure. Approximately 5% to 10% of adults with congenital heart disease (CHD) have PH, and this subset of CHD patients is at higher risk of hospitalization and death. [1][2][3] Understanding the epidemiology of PH associated with CHD (PH-CHD) is not straightforward, however, because definitions of PH-CHD and diagnostic techniques vary. Appropriate diagnosis and the management of PH-CHD rest on identifying the cause of elevated PAP: high pulmonary venous pressure, high pulmonary vascular resistance, high pulmonary flow, or some combination of these factors, which are referred to throughout this review as passive, resistive, hyperkinetic, and polygenic PH, respectively (Table 1).Prognosis in PH-CHD depends on the underlying cause, pulmonary vascular pathophysiology, and the interaction between the right heart and pulmonary circulation. Adult CHD is heterogeneous, with myriad permutations of underlying defects, previous interventions, and associated comorbidities. Although comprehensive understanding of clinical context is a prerequisite, identifying the optimal therapy for a patient with PH-CHD depends more heavily on an understanding of pathophysiology than it does on the underlying diagnosis. Therefore, the goal of this review is to frame an understanding of PH-CHD in terms of fundamental cardiopulmonary hemodynamic pathophysiology and to emphasize the clinical assessment and management of situations commonly encountered by adult cardiologists caring for patients with PH-CHD. Classifications of PH and PH-CHDClassification schemes in PH represent clinical perspectives of underlying pathophysiology and tend to parallel fundamental hemodynamic relationships of the pulmonary circulation. PVR

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“…Although primary early corrective surgery is generally favored, certain scenarios warrant a two-stage approach involving initial palliative banding of the main pulmonary artery (PA), followed by corrective surgery months later (8).…”

Section: Discussionmentioning

confidence: 99%

Efficacy and outcomes of pulmonary artery banding: Our experience in Azerbaijan

Ahmadov,

Musayev

2023

AZJCVS

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Aim: We conducted a retrospective analysis of 35 patients with various congenital heart defects who underwent pulmonary artery banding (PAB) between January 2018 and September 2023. Our objective was to evaluate the outcomes of PAB and discuss its application in a staged approach for these patients. Material and Methods: The median age at PAB was 5 months (range: 2 to 20 months) with a median weight of 5.2 kg (range: 3 to 9 kg). Results: The hospital and total mortality rates were 11.4% (4). The median intensive care unit stay was 2 days (range: 1 to 22 days), and the median hospital stay was 5 days (range: 5 to 36 days). The second stage (either total correction or cava-pulmonary anastomosis) was achieved in 40% (14/35) of patients at a median age of 15 months. The mean interval to repair was 8 months, with 12 out of 14 patients undergoing complete biventricular repair. Conclusion: Our study demonstrates that PAB could be performed with acceptable outcomes, serving as a viable palliative measure for neonates and extremely small infants who are at high risk for cardiopulmonary bypass. Our study results exhibit a comparable trend to previously reported findings, emphasizing the importance of PAB in managing congenital heart malformations characterized by increased pulmonary blood flow. While the effectiveness of PAB has been validated in our study, future investigations could delve into refining surgical protocols, optimizing band adjustment techniques, and exploring potential preventive measures for common postoperative complications.

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Alternative approach for selected severe pulmonary hypertension of congenital heart defect without initial correction — Palliative surgical treatment

Cited by 12 publications

References 14 publications

Pediatric Pulmonary Hypertension

Pediatric Pulmonary Hypertension

Clinical Evaluation and Management of Pulmonary Hypertension in the Adult With Congenital Heart Disease

Efficacy and outcomes of pulmonary artery banding: Our experience in Azerbaijan

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