Prediction of Operability by Pulmonary Artery Acceleration Time and Right Ventricular Ejection Time in Large Ventricular Septal Defects with Severe Pulmonary Arterial Hypertension

Abstract

Background: Diagnosing and treating cardiopulmonary illnesses in children depend heavily on evaluating pulmonary hemodynamics. Severe pulmonary artery hypertension (PAH) and Eisenmenger’s syndrome are most frequently seen in post-tricuspid shunts. Right heart catheterization is the gold standard test for calculating pulmonary vascular resistance and pulmonary artery pressures, but it has many flaws, especially regarding shunt abnormalities. Right ventricular ejection and pulmonary artery acceleration times can be useful alternatives for determining pulmonary vascular resistance. Aims and Objectives: This study aimed to correlate pulmonary artery acceleration time (PAAT) and right ventricular ejection time (RVET) with PAH. Materials and Methods: We included 52 patients with large ventricular septal defects (VSD) and severe pulmonary artery hypertension. All children with large VSD and severe PAH admitted for diagnostic catheterization after satisfying the inclusion criteria were included in the study following approval from the institutional ethics committee. All pre-catheterization echocardiographic data were collected with a Philips iE33 ultrasound machine. All of them underwent diagnostic catheterizations. Results: We observed that the chance of operability was high earlier in the age of presentation. PAAT: RVET had a positive correlation with Qp:Qs (pulmonary flow: systemic flow) and were negatively correlated with pulmonary vascular resistance index (PVRI), pulmonary vascular resistance: systemic vascular resistance (PVR:SVR), and mean pulmonary artery pressure (mPAP). In our study, we found that both PAAT and PAAT: RVET were moderately negatively correlated with PVRI and PVR: SVR (r: -0.72, P < 0.001, r: -0.71, P < 0.001 and r: -0.67, P < 0.001, r: -0.71, P < 0.001 respectively). PAAT and PAAT: RVET were moderately negatively correlated with mPAP (r: -0.7. P < 0.001; r: -0.71, P < 0.001 respectively) and positively with Qp:Qs (r: +0.63, P < 0.001; r: 0.67, P < 0.001 respectively). Conclusion: PAAT and PAAT: RVET index are important parameters in assessing pulmonary arterial pressure in large VSD with severe PAH.