No abstract

Introduction: Left to right shunt in congenital heart disease is the common causes of pulmonary hypertension (PH) in children, and the pulmonary pressure sometime isn’t recovered to normal value after the shunts closed. Residual PH after correcting these shunts may cause deaths. The purpose of this study was to describe the rate of residual PH after surgical closure the left to right shunts in pediatric congenital heart disease and determine its risk factors. Patients and methods: A retrospective study was performed on the medical recorded documents of 59 children who were diagnosed pulmonary artery hypertension associated with common left to right shunt congenital heart diseases and performed shunt closure surgically at Cho Ray hospital between January 2020 and May 2022. Systolic pulmonary artery pressure (PAPs) was measured via tricuspid regurgitation jet on transthoracic echocardiography (mode: continuous wave doppler, plane: apical 4-chamber). PH was defined as PAPs ≥ 40mmHg. Postoperative PAPs was measured 1 day before discharge. Results: The median age and weight at surgery were 7 months (2 – 215) and 5.9 kg (3.6 – 35), 59.3% was female. Preoperatively, 66.1% were mild PH, 33.9% moderate. Postoperatively, 10 patients (17%) diagnosed residual PH and all was mild. Among 10 patients with residual PH: 7 were combined defects (5 VSD-PDA, 2 VSD-ASD), 3 simple defects (2 VSD, 1 ASD). Preoperative high pulmonary pressure was associated with residual PH (correlation coefficient 0.116, p = 0.001). Conclusions: The proportion of patients with postoperatiovely residual PH is significant and most of these cases are combined shunt. Preoperative high pulmonary pressure is related to residual PH.

Transposition of the great arteries (TGA) is a complex cyanotic congenital heart disease, and only 10% of children with TGA can be alive through infancy. Rastelli operation is a standard surgical method for patient with TGA associated with ventricular septal defect (VSD) and pulmonary stenosis (PS). The aim of this report was to show short-term outcome of Rastelli operation in TGA; 3 patients (aged from 3 months to 4 years) were diagnosed TGA, VSD, atrial septal defect (ASD) and PS (2 severe pulmonary stenosis, 1 pulmonary atresia) with cyanosis, failure to thrive, baseline oxygen saturation values of 62% to 75%. All of 3 was performed Rastelli procedure and hospital discharged after 14 – 17 days postoperatively with saturation > 95%, no early complication, reoperation or death. Rastelli procedure in TGA  associated with VSD, ASD and PS is initially well performed at the department of Pediatric Cardiac Surgery, Cho Ray hospital with satisfactory short-time outcome