The unidirectional valve patch provides no benefits to early and long-term survival in patients with ventricular septal defect and severe pulmonary artery hypertension

Gan, Hui-Li; Zhang, Jianqun; Zhang, Zhao‐Guang; Luo, Yumin; Zhou, Qiwen; Bo, Ping

doi:10.1016/j.jtcvs.2009.05.047

Cited by 10 publications

(4 citation statements)

References 15 publications

(14 reference statements)

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“…We expect to shortly provide more data in this direction. Our findings are in sharp contrast to a recent study from China [15] in which 876 patients with VSD and PAH underwent VSD closure. In 195 of these, a UVP was used to close the VSD.…”

Section: Discussioncontrasting

confidence: 99%

Unidirectional valved patch closure of ventricular septal defects with severe pulmonary arterial hypertension

Talwar

Choudhary

Garg

et al. 2012

Interactive CardioVascular and Thoracic Surgery

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Delayed presentation of ventricular septal defect (VSD) is common in developing countries. Such patients often have severe pulmonary arterial hypertension (PAH), which increases post-operative morbidity and mortality. To address these problems, we used our technique of unidirectional valved patch (UVP) for closure of VSD. Between January 2006 and December 2010, 17 patients (age 2-23 years, median 9 years) with a large VSD and severe PAH underwent VSD closure with UVP. Pre-operative mean indexed pulmonary vascular resistance (PVRI) was 10.9 ± 2.2 Wood units and mean pre-operative systemic saturation was 93.4 ± 2.6%. Shunt was bidirectional in 15 patients and predominantly right to left in two. After VSD closure, intra-operative transoesophageal echocardiography revealed a right to left shunt across the patch in three patients 2, 7 and 9 years of age who had pre-operative PVRI of 9.5, 9.8 and 11.1 Wood units, respectively. There were no in-hospital deaths and all patients had uneventful recovery. Mean follow-up was 30 ± 14.7 months and all patients are well without cyanosis. Echocardiography showed no shunt across the patch and all have systemic saturation >95%. We conclude that UVP is a promising technique in patients with large VSD and severe PAH.

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Section: Discussioncontrasting

confidence: 99%

Unidirectional valved patch closure of ventricular septal defects with severe pulmonary arterial hypertension

Talwar

Choudhary

Garg

et al. 2012

Interactive CardioVascular and Thoracic Surgery

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“…Today, two main surgical strategies, a unidirectional valve patch and a simple patch are used in these patients. Gan and colleagues 6 emphasized that a unidirectional valve patch provides no benefits in terms of early or long-term survival, whereas some authors have reported better early results in children and adults with increased PVR. 1 , 3…”

Section: Discussionmentioning

confidence: 99%

Valve patch technique for repair of ventricular septal defect: long-term results

Afrasiabirad

Saifeddine

Vatani

et al. 2020

Asian Cardiovasc Thorac Ann

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Objective This study aimed to show the long-term results in patients who underwent unidirectional valve patch repair of ventricular septal defect with pulmonary artery hypertension. Methods Thirty-five acyanotic patients aged 2 to 26 years (mean 9.3 years) with a large ventricular septal defect and elevated pulmonary vascular resistance (mean 9.5 Wood units) underwent surgery in Madani Heart Hospital. The medical records and clinical outcomes were reviewed from March 1998 to March 2017. Results Five patients died in the first postoperative week. In the long-term follow-up (mean 11 years), two patients were lost to follow-up. Pulmonary artery hypertension gradually decreased in 17 patients within 6–12 months with significant improvement in right ventricular end-diastolic diameter, New York Heart Association functional class, and tricuspid regurgitation. Eleven patients with persistent pulmonary artery hypertension were divided into tolerable and non-tolerable groups. Six patients in the tolerable group had satisfactory conditions compared to before the operation, and gained weight with improved functional class despite echocardiographic findings of persistent elevated pulmonary artery pressure. One had a full-term delivery by caesarean section in the fifth postoperative year. Five patients in the non-tolerable group gradually developed right heart failure and complications such as extremity edema, ascites, pleural effusions, and died after 10–30 months. Conclusion Although relatively high mortality occurred during long-term follow-up, surviving patients were in a better condition and functional class despite persistent pulmonary artery hypertension. Therefore, fear of persistent pulmonary artery hypertension should not prohibit surgery in this group of patients.

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“…In addition, Eisenmenger syndrome is more likely to develop in patients with large aortopulmonary or interventricular shunts [11]. While there are some data regarding surgical repair for PAH-CHD in adults, very little is known about the long-term outcome of defect closure in this patient group [12,13,14].…”

Section: Discussionmentioning

confidence: 99%

Two-stage surgery for a large ventricular septal defect and patent ductus arteriosus associated with severe pulmonary arterial hypertension in an adult patient

et al. 2018

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Introduction Adult patients with pulmonary arterial hypertension (PAH) associated with congenital left-to-right shunting are often considered inoperable. Case outline A 26-year-old man presented with effort intolerance and palpitations. The diagnosis of PAH in the presence of a large perimembranous ventricular septal defect (VSD) and patent ductus arteriosus (PDA) was established. The patient was managed with a two-stage surgical approach involving an initial ligation of PDA, followed by VSD closure using unidirectional valved patch. Treatment decisions were based on the results of both invasive and non-invasive investigations. At follow-up, the patient was asymptomatic with pulmonary arterial pressure and vascular resistance returning to normal levels. Conclusion There is a possibility for an adult patient to have a congenital heart disease associated with marked pulmonary overcirculation that is still amenable to surgical repair. This implies that there is an individual response to a long-standing left-to-right shunt, and that the therapy should be considered on a case-by-case basis.

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The unidirectional valve patch provides no benefits to early and long-term survival in patients with ventricular septal defect and severe pulmonary artery hypertension

Abstract: A unidirectional valve patch provides no benefits to early and long-term survival when it is used to deal with ventricular septal defect and severe pulmonary artery hypertension.

Cited by 10 publications

References 15 publications

Unidirectional valved patch closure of ventricular septal defects with severe pulmonary arterial hypertension

Unidirectional valved patch closure of ventricular septal defects with severe pulmonary arterial hypertension

Valve patch technique for repair of ventricular septal defect: long-term results

Two-stage surgery for a large ventricular septal defect and patent ductus arteriosus associated with severe pulmonary arterial hypertension in an adult patient

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