Abstract
The surgical repair of congenital heart defects in children with preoperative pulmonary hypertension (PH) is to varying degree associated with the occurrence of postoperative PH. The objective of this study was to follow up children with severe postoperative PH (pulmonary arterial/aortic pressure ratio ≥ 1.0) to evaluate if pulmonary arterial pressure spontaneously normalized or needed PH-targeting therapy and to identify potential high-risk diagnoses for bad outcome. Twenty-five children who developed clinically significant severe PH on at least three occasions postoperatively were included in the follow-up (20–24 years). Data from chart reviews, echocardiographic investigations, and questionnaires were obtained. Three children died within the first year after surgery. Three children were lost to follow-up. The remaining 17 children normalized their pulmonary arterial pressure without the use of PH-targeting drugs at any time during the follow-up. Two children had a remaining mild PH with moderate mitral valve insufficiency. All three children with bad outcome had combined cardiac lesions causing post-capillary pulmonary hypertension. Normalization of the pulmonary arterial pressure occurred in almost all children with severe postoperative PH, without any need of supplemental PH-targeting therapies. All children with bad outcome had diagnoses conformable with post-capillary PH making the use of PH-targeting therapies relatively contraindicated. These data emphasize the need to perform randomized, blinded trials on the use of PH-targeting drugs in children with postoperative PH before accepting it as an indication for routine treatment.
Highlights
The impact of preoperative pulmonary hypertension (PH) on the outcome after correction of pediatric congenital cardiac defects has been a matter of discussion for a long time [1,2,3]
Some recognize PH in connection with pediatric cardiac surgery as an ominous sign and an increasing number of physicians advocate a preoperative catheterization to determine the pulmonary vascular resistance (PVR) in a child with preoperative PH before the child is accepted for surgical correction of the heart defect
Twenty-five (n = 25) children who developed severe postoperative PH defined as a mean pulmonary arterial pressure equal to or exceeding mean systemic arterial pressure on at least three occasions after pediatric cardiac surgery were included in the follow-up study
Summary
The impact of preoperative pulmonary hypertension (PH) on the outcome after correction of pediatric congenital cardiac defects has been a matter of discussion for a long time [1,2,3]. Some recognize PH in connection with pediatric cardiac surgery as an ominous sign and an increasing number of physicians advocate a preoperative catheterization to determine the pulmonary vascular resistance (PVR) in a child with preoperative PH before the child is accepted for surgical correction of the heart defect. It is of interest to analyze if children with clinically significant postoperative severe PH following pediatric cardiac surgery need PH-targeting drugs to protect the right ventricle or to normalize their pulmonary arterial pressures. We have a unique cohort of 25 children who developed proven severe postoperative PH (pulmonary arterial/aortic pressure ratio, ≥ 1.0) in the era before phosphodiesterase 5 inhibitors and endothelin receptor antagonists were approved in Europe. The cohort was collected during a 5-year period (1994–1998) when we determined the incidence of clinically important postoperative PH in all children scheduled for open heart surgery [9]. A pulmonary artery catheter was placed in the main pulmonary artery through the right
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
