Ventricular septal defect with increased pulmonary vascular resistance

Friedli, Béat; Kidd, Bruce; Mustard, W. T.; Keith, John D.

doi:10.1016/0002-9149(74)90323-3

Cited by 101 publications

(45 citation statements)

References 15 publications

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“…High pulmonary arterial pressures and elevated pulmonary vascular resistance can cause reversal of the left to right shunt leading to inoperability in these patients. Hence, the cardiac defects with left to right shunts are best repaired before pulmonary vascular changes become irreversible [6,7]. Though clinical examination and cardiac catheterization has been used to predict the extent of pulmonary vascular changes, they have been found to be inaccurate.…”

Section: Discussionmentioning

confidence: 99%

“…In these patients; surgical outcome in operable cases depends on the degree of pulmonary arterial pressure and pulmonary vascular resistance. In patients with high pulmonary arterial pressure, there may be a reversal of shunt leading to inoperability [5,6]. It would be ideal to perform corrective surgery before the pulmonary vascular changes become irreversible, but there is no gold standard for assessing the severity of pulmonary vascular disease.…”

Section: Introductionmentioning

confidence: 99%

“…It would be ideal to perform corrective surgery before the pulmonary vascular changes become irreversible, but there is no gold standard for assessing the severity of pulmonary vascular disease. Intra-operative lung biopsy is a technically simple investigation that can be used for the same purpose [6,7].…”

Section: Introductionmentioning

confidence: 99%

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Study of Pulmonary Arterial Pressures and Histopathological Changes in Patients Having Congenital Heart Defects with Left-to-Right Shunt

2010

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Pulmonary arterial hypertension, a common complication in patients with congenital heart defects with left-to-right shunt who present late is one of the principal determinants of the clinical manifestations, the course and the feasibility of surgical repair. The objective is to study the pulmonary arterial pressures and the pulmonary histopathological changes in patients having congenital heart defects with left-to-right shunt. A total of 20 consecutive patients having congenital heart defects with left-to-right shunt who underwent surgical correction were studied. Intra-operative mean pulmonary arterial pressures were measured before and after surgical correction. Lung biopsy was taken to study the histopathological changes of lung parenchyma and vasculature. All patients, irrespective of age at the time of surgical repair and the type and size of the cardiac defect had raised mean pulmonary arterial pressures that were decreased significantly immediately after surgical correction. Pulmonary parenchymal changes and vascular changes were noted in 18 and 9 patients respectively. The pulmonary vascular changes were significantly correlated with the mean pulmonary arterial pressures. The pulmonary parenchymal changes though were a consistent finding; not significantly correlated with the mean pulmonary arterial pressures.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Study of Pulmonary Arterial Pressures and Histopathological Changes in Patients Having Congenital Heart Defects with Left-to-Right Shunt

2010

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“…In 1974, Dushane, et al 16,17) suggested that VSD surgery could be performed when Rp ≤ 14 Wood U·m 2 . Friedli, et al 18) reported that Rp > 6 Wood U·m 2 and a pulmonary-to-systemic resistance ratio (Rp/Rs) > 0.3 were associated with increased mortality after VSD surgery. Rp < 8 Wood U·m 2 has also been suggested as an operative indication for VSD surgery.…”

Section: What Are the Operative Indications In Patients With Chd Withmentioning

confidence: 99%

Can Pulmonary Vasodilator Therapy Expand the Operative Indications for Congenital Heart Disease?

Inai

2015

Int. Heart J.

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SummaryThe operability of congenital heart disease with left to right shunt depends on the severity of the pulmonary vascular disease induced by the increased pulmonary blood flow. Although some recommendations exist regarding operative indications according to pathological, hemodynamic, and epidemiological factors, the evidence underlying these recommendations is not conclusive. Recently, oral pulmonary vasodilator therapy has been reported to improve outcomes in patients with idiopathic pulmonary arterial hypertension, and this therapy also appears to be effective in patients with congenital heart disease and pulmonary arterial hypertension, including those with postoperative pulmonary hypertension and Eisenmenger syndrome. It is expected that the availability of novel pulmonary vasodilator therapy will expand the operative indications in patients with congenital heart disease with left to right shunt, but there is currently insufficient evidence to definitively determine this. A multicenter double-blind study should be conducted to further examine this issue. (Int Heart J 2015; 56: S12-S16)

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“…[16] Despite these strategies the “long-term” survival remains unchanged. [7–11] Therefore, these expensive measures are logistically impractical and are a drain on the meager health resources in developing nations.…”

Section: Introductionmentioning

confidence: 99%

Unidirectional valved patches for closure of septal defects in patients with severe pulmonary hypertension

et al. 2008

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Pulmonary hypertension due to delay in presentation, diagnosis, referral, and surgery for septal defects is not uncommon in the developing world and translates into high morbidity and mortality following open heart surgery to close these defects. Leaving a small atrial communication may not always be effective. Extracorporeal membrane oxygenation and inhaled nitric oxide therapy in the immediate postoperative phase may not be available or may not be financially feasible in many institutions which are economically challenged. Unidirectional valved patch is emerging as a new and effective solution to this problem and promises to make at least the immediate postoperative results more predictable in this subset of patients.

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Ventricular septal defect with increased pulmonary vascular resistance

Cited by 101 publications

References 15 publications

Study of Pulmonary Arterial Pressures and Histopathological Changes in Patients Having Congenital Heart Defects with Left-to-Right Shunt

Study of Pulmonary Arterial Pressures and Histopathological Changes in Patients Having Congenital Heart Defects with Left-to-Right Shunt

Can Pulmonary Vasodilator Therapy Expand the Operative Indications for Congenital Heart Disease?

Unidirectional valved patches for closure of septal defects in patients with severe pulmonary hypertension

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