Age is not a good predictor of irreversibility of pulmonary hypertension in congenital cardiac malformations with left-to-right shunt.

Détails

ID Serval
serval:BIB_7BF7FA94B7AF
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Age is not a good predictor of irreversibility of pulmonary hypertension in congenital cardiac malformations with left-to-right shunt.
Périodique
Congenital heart disease
Auteur(s)
Hosseinpour A.R., Perez M.H., Longchamp D., Cotting J., Sekarski N., Hurni M., Prêtre R., Di Bernardo S.
ISSN
1747-0803 (Electronic)
ISSN-L
1747-079X
Statut éditorial
Publié
Date de publication
03/2018
Peer-reviewed
Oui
Volume
13
Numéro
2
Pages
210-216
Langue
anglais
Notes
Publication types: Journal Article ; Observational Study
Publication Status: ppublish
Résumé
Congenital cardiac malformations with high pulmonary blood flow and pressure due to left-to-right shunts are usually repaired in early infancy for both the benefits of early relief of heart failure and the fear that the concomitant pulmonary hypertension may become irreversible unless these defects are corrected at an early age. Age, however, has been a poor predictor of irreversibility of pulmonary hypertension in our experience, which is presented here.
A retrospective observational study. We defined "late" as age ≥2 years. We examined clinical, echocardiographic, and hemodynamic data from all patients aged ≥2 years with such malformations referred to us from 2004 untill 2015.
Department of Pediatric Cardiology and Cardiac Surgery, University Hospital of Vaud, Lausanne, Switzerland.
There were 39 patients, aged 2-35 years (median: 5 years), without chromosomal abnormalities. All had malformations amenable to biventricular repair, and all had high systolic right ventricular pressures by echocardiography prior to referral.
All patients underwent catheterization for assessment of pulmonary hypertension. If this was reversible, surgical correction was offered.
(1) Operability based on reversibility of pulmonary hypertension. (2) When surgery was offered, mortality and evidence of persisting postoperative pulmonary hypertension were examined.
Eighteen patients had no pulmonary hypertension, 5 of variable ages were inoperable due to irreversible pulmonary hypertension, and 16 had reversible pulmonary hypertension. Therefore, 34 patients underwent corrective surgery, with no immediate or late mortality. Pulmonary arterial and right ventricular pressures decreased noticeably in all operated patients. This is sustained to date; they are all asymptomatic with no echocardiographic evidence of pulmonary hypertension at a median follow-up of 7 years (range 2-13 years).
Pulmonary hypertension may still be reversible in many surprisingly old patients with left-to-right shunt lesions, who may therefore still be operable.
Mots-clé
Adolescent, Adult, Age Factors, Cardiac Catheterization, Cardiac Surgical Procedures, Child, Child, Preschool, Disease Progression, Eisenmenger Complex/complications, Eisenmenger Complex/diagnosis, Eisenmenger Complex/surgery, Female, Follow-Up Studies, Hemodynamics/physiology, Humans, Hypertension, Pulmonary/epidemiology, Hypertension, Pulmonary/etiology, Hypertension, Pulmonary/physiopathology, Incidence, Male, Prognosis, Pulmonary Artery/diagnostic imaging, Pulmonary Artery/physiopathology, Retrospective Studies, Risk Factors, Survival Rate/trends, Switzerland/epidemiology, Young Adult, Eisenmenger syndrome, congenital heart disease, left-to-right shunt, pulmonary hypertension, pulmonary vascular disease
Pubmed
Web of science
Création de la notice
09/11/2017 19:18
Dernière modification de la notice
20/08/2019 14:37
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