Effects on pulmonary arterial systolic pressure after surgical closure of ventricular septal defect
DOI:
https://doi.org/10.18203/2349-2902.isj20262988Keywords:
Congenital heart disease, Echocardiography, Pulmonary hypertension, Pulmonary arterial systolic pressure, Surgical closure, Ventricular septal defectAbstract
Background: Pulmonary arterial hypertension (PAH) is a common complication of ventricular septal defect (VSD) caused by chronic left-to-right shunting and increased pulmonary blood flow. This study evaluated the effect of surgical VSD closure on pulmonary arterial systolic pressure (PASP) in patients with varying degrees of pulmonary hypertension.
Methods: This prospective observational study was conducted in the Department of Cardiac Surgery, Bangladesh Medical University (BMU), Dhaka, Bangladesh, from July 2022 to June 2024. Sixty patients with isolated VSD and pulmonary hypertension who underwent elective surgical closure were enrolled and divided into three groups according to preoperative PASP: Group A (36–45 mmHg), Group B (46–60 mmHg) and Group C (>60 mmHg). PASP was assessed by transthoracic Doppler echocardiography before surgery, on the first postoperative day, at one month and at three months after surgery. Data were analyzed using SPSS version 26 and a p value <0.05 was considered statistically significant.
Results: The mean age ranged from 5.98±4.31 to 6.33±3.88 years, with no significant differences in age or sex distribution among the groups. PASP decreased progressively following surgical closure in all groups. Significant reductions were observed on the first postoperative day and at one month (p<0.001). By three months, mean PASP decreased to 27.80±7.96 mmHg, 28.40±4.95 mmHg and 30.05±9.83 mmHg in Groups A, B and C, respectively, with no significant difference among the groups (p=0.285). One postoperative death occurred in the severe pulmonary hypertension group.
Conclusions: Surgical closure of VSD significantly reduces pulmonary arterial systolic pressure across all grades of pulmonary hypertension. Early surgical intervention may facilitate reversal of pulmonary hypertension and improve postoperative hemodynamic outcomes.
References
Hoffman JIE, Kaplan S. The incidence of congenital heart disease. J Am Coll Cardiol. 2002;39(12):1890-900.
Penny DJ, Vick GW III. Ventricular septal defect. Lancet. 2011;377(9771):1103-12.
van der Linde D, Konings EEM, Slager MA, Witsenburg M, Helbing WA, Takkenberg JJM, et al. Birth prevalence of congenital heart disease worldwide: a systematic review and meta-analysis. J Am Coll Cardiol. 2011;58(21):2241-7.
Baumgartner H, De Backer J, Babu-Narayan SV, Budts W, Chessa M, Diller GP, et al. 2020 ESC Guidelines for the management of adult congenital heart disease. Eur Heart J. 2021;42(6):563-645.
Galiè N, Humbert M, Vachiery JL, Gibbs S, Lang I, Torbicki A, et al. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J. 2016;37(1):67-119.
Simonneau G, Montani D, Celermajer DS, Denton CP, Gatzoulis MA, Krowka M, et al. Haemodynamic definitions and updated clinical classification of pulmonary hypertension. Eur Respir J. 2019;53(1):1801913.
Stout KK, Daniels CJ, Aboulhosn JA, Bozkurt B, Broberg CS, Colman JM, et al. 2018 AHA/ACC Guideline for the management of adults with congenital heart disease. Circulation. 2019;139(14).
Beghetti M, Galiè N. Eisenmenger syndrome: a clinical perspective in a new therapeutic era of pulmonary arterial hypertension. J Am Coll Cardiol. 2009;53(9):733-40.
Rosenzweig EB, Abman SH, Adatia I, Beghetti M, Bonnet D, Haworth S, et al. Paediatric pulmonary arterial hypertension. Eur Respir J. 2019;53(1):1801916.
Abman SH, Hansmann G, Archer SL, Ivy DD, Adatia I, Chung WK, et al. Pediatric pulmonary hypertension: guidelines from the American Heart Association and American Thoracic Society. Circulation. 2015;132(21):2037-99.
Kirklin JK, Barratt-Boyes BG. Cardiac Surgery. 4th ed. Philadelphia: Elsevier Saunders; 2013.
Mavroudis C, Backer CL. Pediatric Cardiac Surgery. 5th ed. Hoboken: Wiley-Blackwell. 2023.
Anderson RH, Baker EJ, Penny DJ, Redington AN, Rigby ML, Wernovsky G. Paediatric Cardiology. 4th ed. Philadelphia: Elsevier. 2020.
Haworth SG. Pulmonary hypertension in the young. Heart. 2002;88(6):658-64.
Dimopoulos K, Wort SJ, Gatzoulis MA. Pulmonary hypertension related to congenital heart disease. Eur Respir Rev. 2014;23(134):308-22.
Sluysmans T, Colan SD. Theoretical and empirical derivation of cardiovascular allometric relationships in children. J Appl Physiol. 2005;99(2):445-57.
Talwar S, Choudhary SK, Airan B. Surgical management of ventricular septal defect with pulmonary hypertension: early and mid-term outcomes. Asian Cardiovasc Thorac Ann. 2014;22(5):547-53.
D'Alto M, Mahadevan VS. Pulmonary arterial hypertension associated with congenital heart disease. Eur Respir Rev. 2012;21(126):328-37.
Akilov V, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola VP, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism. Eur Heart J. 2020;41(4):543-603.
Zoghbi WA, Adams D, Bonow RO, Enriquez-Sarano M, Foster E, Grayburn PA, et al. Recommendations for non-invasive evaluation of native valvular regurgitation. J Am Soc Echocardiogr. 2017;30(4):303-71.
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