Indications for open lung biopsy in patients with ventricular septal defect and/or patent ductus arteriosus with pulmonary hypertension

Abstract

In a previous paper, it was stated that open lung biopsy for determination of operative indications could be recommended if pulmonary vascular resistance (PVR) were higher than 8 units.m2 in patients with ventricular septal defect (VSD) and/or patent ductus arteriosus (PDA) with severe pulmonary hypertension. In the present study, oxygen inhalation or Tolazoline administration tests with or without occlusion of ductus arteriosus were performed during cardiac catheterization in 47 patients with VSD and/or PDA with severe pulmonary hypertension. The results obtained were compared with the operability based on our histopathological diagnostic criteria. There was no correlation between the oxygen, Tolazoline, or ductus occlusion hemodynamics and the baseline hemodynamics for better prediction of the biopsy should be performed for the determination of operative indication when patients with VSD and/or PDA have a PVR higher than 8 units.m2, and if the PVR is greater than 4 units.m2 with the oxygen inhalation test or 7 units.m2 with the Tolazoline test.

Pulmonary vascular disease associated with pulmonary hypertension in 445 patients: diagnosis from lung biopsy and autopsy

“…Indication for lung biopsy in ventricular septal defect (VSD) and/or patent ductus arteriosus (PDA) and atrioventricular septal defect (AVSD) was determined based on the previously reported hemodynamic criteria. [1] In general, we evaluated whether surgery was indicated according to the index of pulmonary vascular disease (IPVD) [2] and the Heath–Edwards (HE) classification. [3] To obtain the IPVD score, the severity of each occlusive pulmonary vascular lesion in the small pulmonary arteries was categorized as grade 1–4 and an arithmetic average for all lesions was calculated in each case.…”

“…Goldner’s trichrome stain combined with Weiger’s stain for elastic fibers was performed [1, 2, 4–14]. …”

Progressive pulmonary vascular disease after pulmonary artery banding and total correction in a case of ventricular septal defect and pulmonary hypertension

“…Although moderate pulmonary hypertension remained, these hemodynamic data have usually forecasted thinning in the hypertrophied media and a shrinkage in the thickened intima of the small pulmonary arteries after PAB . 8 Therefore, we performed total correction at 12 months after the PAB. However, the lung biopsy which was taken just after the VSD closure showed an elevated value of IPVD, predicting a poor outcome.…”

“…The relative hypoxia after surgery may be responsible for vasoconstriction and medial thickening. 8 In simple VSD as well, pulmonary oxygen saturation generally decreases after VSD closure, although not so much as in TGA. In the present case, we concluded that in the presence of severe pulmonary hypertension remaining after the total correction, medial hypertrophy may have further progressed due to vasoconstriction triggered by a lowered oxygen saturation of the pulmonary arterial blood, and that further vasoconstriction caused necrosis in the extremely thickened media.…”

Surgical management of muscular trabecular ventricular septal defects

“…Lung biopsy is also an important tool for evaluating conditions of pulmonary vascular beds in patients with severely high pulmonary resistance. 17 Pulmonary artery banding Despite increasingly favored trends toward early primary closure of VSDs to avoid palliation, there are still some instances for which banding the main pulmonary artery to stabilize hemodynamic conditions and delay defi nitive repair in trabecular VSDs is appropriate. Examples include patients in whom complicated anomalies are associated with hemodynamic instability or high pulmonary resistance.…”