Pulmonary arterial changes in patients with ventricular septal defects and severe pulmonary hypertension

1986 ◽  
Vol 7 (3) ◽  
pp. 147-154 ◽  
Author(s):  
Ruthellen Fried ◽  
George Falkovsky ◽  
Jane Newburger ◽  
A. I. Gorchakova ◽  
Marlene Rabinovitch ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Severe Pulmonary Hypertension ◽  
Ventricular Septal Defects ◽  
Septal Defects ◽  
Pulmonary Arterial

Abstract 15801: Early and Late Risk of Mortality or Development of Severe Pulmonary Hypertension Following Closure of Ventricular Septal Defects in Children With Severe Pulmonary Hypertension and Elevated Pulmonary Vascular Resistance Using Traditional or Uni-directional Flap Valve Patch Closure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
William M Novick ◽  
Oleksandr Golovenko ◽  
Vasyl Lazorhyshynets ◽  
Vitaly Dedovich ◽  
Iryna Perepeka ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Vascular Resistance ◽  
Vascular Resistance ◽  
Severe Pulmonary Hypertension ◽  
Ventricular Septal Defects ◽  
Risk Of Death ◽  
Septal Defects ◽  
Number Of Patients ◽  
Flap Valve

Introduction: Children with large ventricular septal defects, severe pulmonary hypertension (PHT), and elevated pulmonary vascular resistance (PVR) are frequently denied operation in low and middle-income countries secondary to concerns of high mortality and development of severe pulmonary hypertension following operation, early and late. Hypothesis: We hypothesized that closure with a uni-directional flap valve patch (DP) would provide lower mortality and better survival without severe PHT. Methods: From 5/96 - 12/2016 all patients undergoing VSD closure with severe PHT and elevated PVR by either traditional (TP) or DP closure were followed annually. Baseline and O 2 provocation catheterization were performed before operation. Echocardiograms were performed at discharge and follow-up. The decision on TP or DP closure was based upon age and surgeon preference. Beginning in 2005 all patients regardless of technique received sildenafil 3 mgs/kg/day for 3 months before operation. Results: The number of patients receiving operation was 129, of which 40 received the DP. Males were 66/129, age and weight differed significantly for DP group compared to the TP group (7.5 vs 2.6 years, p<0.001 and 20 vs 11.5 kgs, p<0.001).Catheterization baseline data, PVR 9.0 vs 7.4 for DP and TP respectively (p<0.001), negative vasoactive test 32.5% vs 13.5% for DP and TP respectively (p=0.016). Mortality was 1/40 for DP and 9/89 for TP. Pulmonary to Systemic systolic pressure ratio was lower at discharge vs baseline cath (0.38 vs 0.99, p<0.001). Predictors of late severe pulmonary hypertension were PVR/SVR >0.5, p<0.024; and a negative vasoactive test of <10% decrease, p<0.001. PHT at last follow-up, none or mild 86/115 (74.8%), moderate 16/115 (13.9%) or severe 13/115 (11.3%). Conclusions: DP patients had less risk of death and both groups had few patients with severe PHT at late follow-up..

Surgical repair of atrial septal defect with severe pulmonary hypertension during pregnancy: a case report with literature review

2012 ◽  
Vol 22 (5) ◽  
pp. 493-498 ◽  
Author(s):  
Suganya Manivannan ◽  
Gul Dadlani ◽  
Michael Parsons ◽  
Luminita Crisan ◽  
Victoria Belogolovkin ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Atrial Septal Defect ◽  
Septal Defect ◽  
Surgical Repair ◽  
Severe Pulmonary Hypertension ◽  
Secundum Atrial Septal Defect ◽  
Viable Option ◽  
Surgical Closure ◽  
Septal Defects ◽  
Pulmonary Arterial

AbstractWe are reporting a case of a 37-year-old pregnant woman with a large secundum atrial septal defect with left-to-right shunt and severe pulmonary hypertension. Her atrial septal defect was undiagnosed before this pregnancy. After carefully considering all the options, we repaired her atrial septal defect with an open heart surgical closure at 20 weeks of gestation. A substantial and consistent reduction in pulmonary arterial pressure after the surgery and subsequent uneventful delivery indicate that surgical repair of atrial septal defects is a viable option that should be considered for such patients.

EARLY SURGICAL CORRECTION OF LARGE VENTRICULAR SEPTAL DEFECTS

PEDIATRICS ◽  
1967 ◽  
Vol 39 (1) ◽  
pp. 4-13
Author(s):  
Joan M. Sigmann ◽  
Aaron M. Stern ◽  
Herbert E. Sloan
Keyword(s):  
Pulmonary Hypertension ◽  
Septal Defect ◽  
Pulmonary Infections ◽  
Severe Pulmonary Hypertension ◽  
Ventricular Septal Defects ◽  
Specific Therapy ◽  
Surgical Closure ◽  
Early Correction ◽  
Septal Defects ◽  
Pulmonary Vascular Obstructive Disease

A significant number of babies born with large ventricular septal defects present early in life as problems in management of congestive heart failure, severe pulmonary hypertension, marked growth retardation, and recurrent pulmonary infections. Review of patients born since December 1954 with ventricular septal defects and followed at our institution allowed for comparison between infants treated surgically and those patients treated either medically or requiring no specific therapy. In 45 infants direct surgical closure of the ventricular defect was undertaken when supportive medical management alone appeared to be inadequate to insure survival or a normal life potential. There was an 80% survival with surgery. All 9 deaths occurred in patients having severe pulmonary hypertension; in some instances additional factors were believed to have contributed to the death of the infant. Nonetheless, surgical mortality appeared to be lower in the infants having severe pulmonary hypertension than among children with a comparable degree of hypertension who were operated on over the age of 2 years. Postmortem examination revealed pathologic changes of advanced pulmonary vascular obstructive disease at as early an age as 8 months. Direct surgical closure of the ventricular septal defect was chosen in preference to the pulmonary artery handing procedure because it not only offers an immediate means of helping the sick infant but also should obviate the necessity of a second major surgical procedure when the patient is older. It is further anticipated that early correction of the septal defect will prove effective in many instances in preventing the serious consequences of pulmonary hypertension.

Management of Infants with Ventricular Septal Defects

PEDIATRICS ◽  
1967 ◽  
Vol 40 (1) ◽  
pp. 144-145
Author(s):  
JOHN H. K. VOGEL ◽  
S. GILBERT BLOUNT
Keyword(s):  
Pulmonary Hypertension ◽  
Medical Therapy ◽  
Surgical Procedures ◽  
Surgical Correction ◽  
Severe Pulmonary Hypertension ◽  
Ventricular Septal Defects ◽  
Septal Defects ◽  
January Issue

The article "Early Surgical Correction of Large Ventricular Septal Defects" by Sigmann, Stern, and Sloan which appeared in the January issue of Pediatrics (39:4, 1967) again illustrates the great concern in properly dealing with infants having such defects. Their 30% mortality in infants under 2 years of age with severe pulmonary hypertension is truly a remarkable surgical feat. However, as indicated by Dr. Nadas, in the preceding commentary, this must be weighed against the results of medical therapy and palliative surgical procedures.

scholarly journals A Case of Osseocartilaginous Defects and Cardiovascular Anomalies: An Ambiguous Entity

2022 ◽  
Vol 1 ◽  
Author(s):  
Aritra Paul ◽  
Aruni Ghose ◽  
Debasish Banerjee ◽  
Suvro Banerjee
Keyword(s):  
Pulmonary Hypertension ◽  
Short Stature ◽  
Eisenmenger Syndrome ◽  
Severe Pulmonary Hypertension ◽  
Ventricular Septal Defects ◽  
Cardiac Anomalies ◽  
Septal Defects ◽  
History Of ◽  
Cardiovascular Anomalies

A 24-year-old man presented with a history of palpitation and haemoptysis. He had a short stature, cardiac anomalies and physical deformities, including polydactyly, clubbing, cataracts and cyanosis. Echocardiography was performed, revealing both atrial and ventricular septal defects, along with severe pulmonary hypertension and Eisenmenger syndrome.

Surgical Strategy in Patients with Atrial Septal Defect and Severe Pulmonary Hypertension

2012 ◽  
Vol 15 (2) ◽  
pp. 111 ◽  
Author(s):  
Yang Hyun Cho ◽  
Tae-Gook Jun ◽  
Ji-Hyuk Yang ◽  
Pyo Won Park ◽  
June Huh ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Atrial Septal Defect ◽  
Tricuspid Regurgitation ◽  
Septal Defect ◽  
Maze Procedure ◽  
Severe Pulmonary Hypertension ◽  
Tricuspid Annuloplasty ◽  
Pulmonary Arterial ◽  
Asd Closure

The aim of the study was to review our experience with atrial septal defect (ASD) closure with a fenestrated patch in patients with severe pulmonary hypertension. Between July 2004 and February 2009, 16 patients with isolated ASD underwent closure with a fenestrated patch. All patients had a secundum type ASD and severe pulmonary hypertension. Patients ranged in age from 6 to 57 years (mean � SD, 34.9 � 13.5 years). The follow-up period was 9 to 59 months (mean, 34.5 � 13.1 months). The ranges of preoperative systolic and pulmonary arterial pressures were 63 to 119 mm Hg (mean, 83.8 � 13.9 mm Hg) and 37 to 77 mm Hg (mean, 51.1 � 10.1 mm Hg). The ranges of preoperative values for the ratio of the pulmonary flow to the systemic flow and for pulmonary arterial resistance were 1.1 to 2.7 (mean, 1.95 � 0.5) and 3.9 to 16.7 Wood units (mean, 9.8 � 2.9 Wood units), respectively. There was no early or late mortality. Tricuspid annuloplasty was performed in 14 patients (87.5%). The peak tricuspid regurgitation gradient and the ratio of the systolic pulmonary artery pressure to the systemic arterial pressure were decreased in all patients. The New York Heart Association class and the grade of tricuspid regurgitation were improved in 13 patients (81.2%) and 15 patients (93.7%), respectively. ASD closure in patients with severe pulmonary hypertension can be performed safely if we create fenestration. Tricuspid annuloplasty and a Cox maze procedure may improve the clinical result. Close observation and follow-up will be needed to validate the long-term benefits.

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