Bidirectional Shunt Trajectory in Ventricular Septal Defect With Eisenmenger’s Syndrome

AbstractObjectivesThis study evaluates the efficacy and safety of sildenafil in patients with Eisenmenger's syndrome with special emphasis on haemodynamic parameters and its comparative efficacy in atrial septal defect versus ventricular septal defect patients.MethodsOral sildenafil was given to 22 patients with Eisenmenger's syndrome – eight with atrial septal defect and 14 with ventricular septal defect – after detailed baseline evaluation including a six-minute walk test, echocardiography, and cardiac catheterisation. Patients were followed up for a period of 6 months for functional class assessment and six-minute walk distance. Cardiac catheterisation was repeated in all patients.ResultsA significant improvement in the World Health Organization functional class, six-minute walk distance, mean pulmonary arterial pressure, and pulmonary vascular resistance was noticed. Systemic arterial and mixed venous oxygen saturations were also significantly improved along with improvement in pulmonary blood flow. None showed any significant side effects or worsening of systemic arterial saturation. At baseline, mean pulmonary arterial pressure, pulmonary vascular resistance, and pulmonary/systemic vascular resistance ratios were significantly higher in ventricular septal defect patients than in atrial septal defect patients. Atrial septal defect patients showed better response in clinical as well as haemodynamic parameters.ConclusionsSildenafil is an effective and safe agent for patients with Eisenmenger's syndrome. It improves their functional capacity as well as haemodynamic parameters. The beneficial effects are greater in patients with Eisenmenger's syndrome secondary to atrial septal defect than ventricular septal defect.

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Coarctoplasty and Stenting in a Case of Ventricular Septal Defect With Eisenmenger’s Syndrome

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135114522277 ◽

2014 ◽

Vol 5 (3) ◽

pp. 481-483

Author(s):

Jayaranganath Mahimaiha ◽

Soumya Patra ◽

Anand P. Subramaniun ◽

Usha Mandikal Kodanda Rama Sastry ◽

Kikkeri Hemannasetty Srinivasa ◽

...

Keyword(s):

Ventricular Septal Defect ◽

Septal Defect ◽

Eisenmenger’S Syndrome

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Ventricular Septal Defect with Eisenmenger’s Syndrome

Echocardiographic Atlas of Adult Congenital Heart Disease ◽

10.1007/978-3-319-12934-1_58 ◽

2015 ◽

pp. 183-184

Author(s):

Hakimeh Sadeghian ◽

Zahra Savand-Roomi

Keyword(s):

Ventricular Septal Defect ◽

Septal Defect ◽

Eisenmenger’S Syndrome

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Ventricular Septal Defect, Patent Ductus Arteriosus, and Eisenmenger’s Syndrome

Echocardiographic Atlas of Adult Congenital Heart Disease ◽

10.1007/978-3-319-12934-1_59 ◽

2015 ◽

pp. 185-187

Author(s):

Hakimeh Sadeghian ◽

Zahra Savand-Roomi

Keyword(s):

Ventricular Septal Defect ◽

Patent Ductus Arteriosus ◽

Septal Defect ◽

Ductus Arteriosus ◽

Eisenmenger’S Syndrome ◽

Patent Ductus

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Ventricular Septal Defect

10.1093/med/9780190685157.003.0007 ◽

2018 ◽

Author(s):

Evan R. Serfass ◽

Justin D. Ramos

Keyword(s):

Pulmonary Hypertension ◽

Ventricular Septal Defect ◽

Septal Defect ◽

Surgical Repair ◽

Respiratory Infections ◽

Anesthetic Management ◽

Failure To Thrive ◽

Eisenmenger’S Syndrome ◽

Delayed Sternal Closure ◽

Patient Size

Ventricular septal defect (VSD) is the most common congenital cardiac lesion, and VSDs are found as isolated lesions in up to 20% of children with congenital heart disease. The natural history and pathophysiology of VSD varies by patient age, patient size, anatomic location, and size of the defect. Patients who have large lesions and significant left-to-right shunt resulting in heart failure symptoms, failure to thrive, pulmonary hypertension, or recurrent respiratory infections may be indicated for early surgical repair during infancy. This chapter presents a clinical scenario of a symptomatic infant undergoing primary surgical repair of a VSD to demonstrate principles of the anatomy, pathophysiology, diagnosis, and medical management of patients with VSDs. Anesthetic management is also discussed, considering the effects of left-to-right shunt, pulmonary hypertension, delayed sternal closure, and Eisenmenger’s syndrome.

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