[Screening study of pulmonary arterial hypertension in patients with congenital heart diseases].
OBJECTIVE
To determine the prevalence and influencing factors of pulmonary arterial hypertension (PAH) in patients with congenital heart disease (CHD).


METHODS
Between May 2007 and December 2008, a total of 692 CHD patients admitted into Fuwai Hospital were prospectively enrolled. Doppler echocardiography was employed to measure the level of pulmonary artery systolic pressure (PASP). PAH occurred when there was an increase in PASP > 40 mm Hg (1 mm Hg = 0.133 kPa) at rest. Eisenmenger syndrome was defined when there was a reversed (pulmonary-to-systemic) or bidirectional shunt. The clinical characteristics between the patients with/without PAH and Eisenmenger syndrome were compared and their risk factors analyzed with a multivariate Logistic model.


RESULTS
The underlying conditions included atrial septal defect (n = 187, 27.0%), ventricular septal defect (n = 456, 65.9%) and patent ductus arteriosus (n = 49, 7.1%). The numbers of patients with PAH-CHD and Eisenmenger syndrome were 329 (47.5%) and 105 (15.2%) respectively. Among the PAH-CHD patients, 31.9% of them had Eisenmenger syndrome. The patients with large shunts were at an elevated risk of PAH. Logistic regression analysis showed that advanced age was an independent risk factor of PAH (OR = 1.04, P < 0.001). Compared with atrial septal defect, ventricular septal defect and patent ductus arteriosus increased the risks of PAH (OR = 2.78, P < 0.001 and OR = 2.50, P < 0.001 respectively).


CONCLUSIONS
PAH is a common complication in CHD patients. And ventricular septal defect is the most common pathogenic type of PAH. Advanced age, ventricular septal defect and patent ductus arteriosus are the risk factors of PAH.
Center for Diagnosis & Management of Pulmonary Vascular Diseases, Cardiovascular Institute & Fuwai Hospital, Peking Union Medical College, Beijing 100037, China.
Yun-juan
YJ
Sun
Kun-jing
KJ
Pang
Wei-jie
WJ
Zeng
Hao
H
Wang
Jian-guo
JG
He
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications* / Q000000981:diagnostic imaging; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging / Q000209:etiology*; D007223:Infant; D008297:Male; D011446:Prospective Studies; D014463:Ultrasonography; D055815:Young Adult