Pulmonary vascular resistance during exercise late after repair of large ventricular septal defects

Abstract

Postoperative pulmonary artery pressure and resistance were assessed during exercise in 32 patients late after repair of large ventricular septal defect with pulmonary hypertension. Nineteen patients had a preoperative pulmonary-to-systemic resistance ratio of between 0.15 and 0.50 (group 1) and 13 had a ratio between 0.50 and 0.96 (group 2). Age at the time of operation was 0.9 to 13.0 years (4.6 +/- 3.6) in group 1 and 0.8 to 15.8 years (4.3 +/- 4.2) in group 2. Age at the time of restudy was 9 to 21 years (14.5 +/- 3.0) in group 1 and 9 to 22 years (13.5 +/- 4.1) in group 2. Pulmonary artery pressure was measured in the supine position at rest and during exercise, as were the measurements underlying the calculations of pulmonary vascular resistance. Mean pulmonary artery pressure was 13 to 21 mm Hg (17 +/- 2) and 10 to 26 mm Hg (20 +/- 5) in groups 1 and 2, respectively, at rest, and this increased to 17 to 27 mm Hg (22 +/- 3) and 14 to 39 mm Hg (27 +/- 7) in groups 1 and 2, respectively, during exercise (p < 0.05). Pulmonary vascular resistance was 0.51 to 3.40 U.m2 (1.93 +/- 0.63) and 0.79 to 3.31 U.m2 (2.05 +/- 0.65) in groups 1 and 2 at rest. It was 0.58 to 2.24 U.m2 (1.36 +/- 0.57) and 0.81 to 3.85 U.m2 (2.18 +/- 0.97) in groups 1 and 2 during exercise (p < 0.01). Postoperative pulmonary vascular resistance during exercise correlated well with age at the time of repair in both groups (r = 0.65, p < 0.05 in group 1; r = 0.86, p < 0.001 in group 2). These data suggest that 85% of patients with a preoperative pulmonary-to-systemic resistance ratio of between 0.15 and 0.50 would have normal pulmonary vascular resistance during exercise when operated on at younger than 3.8 years old and 85% of those with a preoperative pulmonary-to-systemic resistance ratio of more than 0.50 would have normal pulmonary vascular resistance during exercise when operated on at younger than 1.1 years.

Patients with Congenital Systemic-to-Pulmonary Shunts and Increased Pulmonary Vascular Resistance: What Predicts Postoperative Survival?

“…Our findings support the idea that some adolescents with high pressure shunts can safely undergo repair. Though this is not a new finding, our finding carries more weight given the much larger number of patients in our study than any previous reports [17], [18], [20].…”

Recommendations for Competitive Sports Participation in Athletes With Cardiovascular Disease: A Consensus Document From the Study Group of Sports Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology

“…12 In addition, patients with mitral valve dysfunction are at risk for developing pulmonary hypertension. Assessment of pulmonary arterial pressure during exercise is indicated and an intermittent increase in systolic pressure to ,35 mmHg may be safely tolerated.…”

Eisenmenger Syndrome

“…In the future, surgical and other therapeutic approaches aimed at reversing vascular remodeling and regenerating the pulmonary microvasculature may be of benefit to our understanding of ES and the optimal management of ES. Early data suggest that the repair of systemic-topulmonary shunts during childhood may be sufficient to reverse the development of pulmonary vascular disease for some patients (58). In other patients, PAH may develop even after closure of a septal defect and may result from an increased burden on the right ventricle due to remodeling of the pulmonary vasculature before surgery (59).…”