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Do preoperative haemodynamic data and reactivity test predict the postoperative reversibility of pulmonary arterial hypertension in patients with large ventricular septal defect and borderline operability?
  1. Anuradha Sridhar1,
  2. Raghavan Subramanyan1,
  3. Nithya Lakshmi1,
  4. Farida Farzana1,
  5. Ravi Ranjan Tripathi1,
  6. Rajasekaran Premsekar1,
  7. Shanthi Chidambaram Pillai1,
  8. Soman Rema Krishna Manohar2,
  9. Ravi Agarwal2,
  10. Kotturathu Mammen Cherian2
  1. 1Department of Pediatric Cardiology, Frontier Life Line Hospital and Dr K M Cherian Heart Foundation, Chennai, India
  2. 2Pediatric Cardiothoracic Surgery, Frontier Life Line Hospital and Dr K M Cherian Heart Foundation, Chennai, India
  1. Correspondence to Dr Anuradha Sridhar, Department of Pediatric Cardiology, Frontier Life Line Hospital and Dr K M Cherian Heart Foundation, R30C, Ambattur Industrial Estate Road, Mogappair West, Chennai 600 101, India; anuradhasridhar9{at}gmail.com

Abstract

Background Decisions to operate on patients with shunt lesions presenting late with severe pulmonary arterial hypertension (PAH) and borderline operability are often not based on precise cut off values of haemodynamic data owing to paucity of studies.

Objective To assess the reliability of the preoperative haemodynamic data and reactivity test in predicting the postoperative reversibility of PAH in patients with isolated large ventricular septal defects (VSDs) and borderline operability.

Patients and method Between 2004 and 2010, 30 patients underwent VSD closure surgically; no early deaths occurred. Twenty-six patients were followed up regularly (mean 39.6±16 months) and one late postoperative death occurred. Fourteen patients who had been followed up for at least 1 year postoperatively underwent cardiac catheterisation.

Results There were 3 responders (asymptomatic patients with pulmonary vascular resistance (PVR) index <3 WU.m2) and 12 non-responders. The following were lower among responders: mean age at surgery (3.2±0.42 vs 11.55±3.29 years, p=0.227), mean baseline PVR index (3.69±0.8 vs 10.57±9.1, p=0.204), average resistance ratio (RR=0.25±0.01 vs 0.59±0.25, p=0.049) and ratio of pulmonary and systemic mean pressures (PAm:SAm ratio) (0.70±0.009 vs 0.87±0.118, p=0.003).

Conclusions Preoperative ‘base line’ PAm:SAm and RR appear to be better predictors of postoperative outcome than other baseline parameters. Preoperative reactivity test had no significant role in predicting postoperative reversibility of PAH at mid-term.

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