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?
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.


METHODS
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.m(2)) 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.
Department of Pediatric Cardiology , Frontier Life Line Hospital and Dr K M Cherian Heart Foundation , Chennai , India.
Anuradha
A
Sridhar
Department of Pediatric Cardiology , Frontier Life Line Hospital and Dr K M Cherian Heart Foundation , Chennai , India.
Raghavan
R
Subramanyan
Department of Pediatric Cardiology , Frontier Life Line Hospital and Dr K M Cherian Heart Foundation , Chennai , India.
Nithya
N
Lakshmi
Department of Pediatric Cardiology , Frontier Life Line Hospital and Dr K M Cherian Heart Foundation , Chennai , India.
Farida
F
Farzana
Department of Pediatric Cardiology , Frontier Life Line Hospital and Dr K M Cherian Heart Foundation , Chennai , India.
Ravi Ranjan
RR
Tripathi
Department of Pediatric Cardiology , Frontier Life Line Hospital and Dr K M Cherian Heart Foundation , Chennai , India.
Rajasekaran
R
Premsekar
Department of Pediatric Cardiology , Frontier Life Line Hospital and Dr K M Cherian Heart Foundation , Chennai , India.
Shanthi
S
Chidambaram Pillai
Pediatric Cardiothoracic Surgery , Frontier Life Line Hospital and Dr K M Cherian Heart Foundation , Chennai , India.
Soman Rema
SR
Krishna Manohar
Pediatric Cardiothoracic Surgery , Frontier Life Line Hospital and Dr K M Cherian Heart Foundation , Chennai , India.
Ravi
R
Agarwal
Pediatric Cardiothoracic Surgery , Frontier Life Line Hospital and Dr K M Cherian Heart Foundation , Chennai , India.
Kotturathu Mammen
KM
Cherian
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