Alternative approach for selected severe pulmonary hypertension of congenital heart defect without initial correction--palliative surgical treatment.
OBJECTIVE
Uncorrected congenital heart defects (CHD) with severe pulmonary hypertension (sPH, systolic pulmonary artery>70% of systolic pressure) are usually considered inoperable. We are curious to know if some selected patients might benefit from palliative operation for those sPH with uncorrected CHD.


METHODS
Adults or adolescents with sPH associated with ventricular septal defect (VSD) with/without great artery anomalies were selected for pulmonary artery banding (PAB) to reduce sPH. The target pulmonary pressure was less than half of the systolic blood pressure after arch or great arteries reconstruction. Repeated catheterization was performed to evaluate the feasibility of defect closure.


RESULTS
Consecutively, 8 patients (age 26 ± 9 years) received PAB as a palliative procedure in the past 8 years without mortality. The pre-PAB systolic pulmonary pressure was 119 ± 9 mmHg. Additional PAB had been applied in 4 of them. All patients showed significant improvement in function class (III to I or II). The mean post-PAB pulmonary pressure decreased significantly (77.5 ± 9.2 mmHg to 42.0 ± 9.0 mmHg) and 6-minute walk test was also found to have great improvement (270 ± 86 m to 414 ± 49 m), but the saturation at rest did not show a difference. Three of them received corrective surgery to close defects over 3-5 years.


CONCLUSIONS
For some selected adult sPH with uncorrected CHD, PAB can work as a palliative procedure to improve their functional class and even provide a chance of total repair.
Lin
Ming-Tai
MT
Pediatric Cardiovascular Surgery, Pediatric Cardiology, National Taiwan University Hospital, Taipei, Taiwan.
Chen
Yih-Sharng
YS
Huang
Shu-Chien
SC
Chiu
Hsin-Hui
HH
Chiu
Shuenn-Nan
SN
Chen
Chun-An
CA
Wu
En-Ting
ET
Chiu
Ing-Sh
IS
Chang
Chung-I
CI
Wu
Mei-Hwan
MH
Wang
Jou-Kou
JK
D000293:Adolescent; D000328:Adult; D006328:Cardiac Catheterization / Q000379:methods*; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D010166:Palliative Care / Q000379:methods*; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods; D055815:Young Adult