Unidirectional valved patch closure of ventricular septal defects with severe pulmonary arterial hypertension: Hemodynamic outcomes

Talwar, Sachin; Keshri, Vikas Kumar; Choudhary, Shiv Kumar; Gupta, Saurabh Kumar; Ramakrishnan, Sivasubramanian; Saxena, Anitá; Kothari, Shyam Sunder; Juneja, Rajnish; Kumar, Guresh; Airan, Balram

doi:10.1016/j.jtcvs.2013.10.052

Cited by 23 publications

(8 citation statements)

References 14 publications

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“…One such example is the diagnosis of pulmonary arterial hypertension (PAH) and the decision of whether to recommend closure of a ventricular septal defect (VSD) or atrial septal defect (ASD) in the adult patient. Closure of a VSD or ASD in the setting of PAH (defined by the American Heart Association (AHA)/American Thoracic Society (ATS) 2015 Guidelines for Pediatric Pulmonary Hypertension as PVRI >3 WU m 2 ) may lead to unacceptable mortality and morbidity, with complications including acute pulmonary hypertensive crisis, right ventricular failure, and respiratory failure . Conversely, failure to close a defect in an adult with nonprohibitive PAH may lead to decreased quality of life and shortened life expectancy .…”

Section: Discussionmentioning

confidence: 99%

Pulmonary vascular resistance index: Getting the units right and why it matters

Kwan

Shavelle

Laughrun

2019

Clinical Cardiology

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Pulmonary vascular resistance (PVR) and PVR index (PVRI) are key variables in a broad range of contexts, including prediction of outcomes in heart and liver transplantation, determining candidacy for closure of atrial or ventricular septal defects, and guiding treatment of pulmonary hypertension. Significant variability exists among the units used to report PVRI in current literature, making the interpretation of data and translation into clinical practice difficult. Here, we will review the measurement and derivation of PVR and PVRI and demonstrate the extent of confusion in the literature. We conducted a literature search of all published articles in PubMed using the term “PVRI.” This yielded 218 sources with defined units for PVRI, including 33 unique variants. Among all reviewed literature, 45.4% of sources reported PVRI with units ending in m 2 (meters squared), which we defined as correct, whereas 54.6% reported PVRI with units not ending in m 2 , which we defined as incorrect. This lack of uniformity has led to considerable confusion among researchers and clinicians, with potentially life‐altering consequences.

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Section: Discussionmentioning

confidence: 99%

Pulmonary vascular resistance index: Getting the units right and why it matters

Kwan

Shavelle

Laughrun

2019

Clinical Cardiology

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“…In addition, Eisenmenger syndrome is more likely to develop in patients with large aortopulmonary or interventricular shunts [11]. While there are some data regarding surgical repair for PAH-CHD in adults, very little is known about the long-term outcome of defect closure in this patient group [12,13,14].…”

Section: Discussionmentioning

confidence: 99%

Two-stage surgery for a large ventricular septal defect and patent ductus arteriosus associated with severe pulmonary arterial hypertension in an adult patient

et al. 2018

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Introduction Adult patients with pulmonary arterial hypertension (PAH) associated with congenital left-to-right shunting are often considered inoperable. Case outline A 26-year-old man presented with effort intolerance and palpitations. The diagnosis of PAH in the presence of a large perimembranous ventricular septal defect (VSD) and patent ductus arteriosus (PDA) was established. The patient was managed with a two-stage surgical approach involving an initial ligation of PDA, followed by VSD closure using unidirectional valved patch. Treatment decisions were based on the results of both invasive and non-invasive investigations. At follow-up, the patient was asymptomatic with pulmonary arterial pressure and vascular resistance returning to normal levels. Conclusion There is a possibility for an adult patient to have a congenital heart disease associated with marked pulmonary overcirculation that is still amenable to surgical repair. This implies that there is an individual response to a long-standing left-to-right shunt, and that the therapy should be considered on a case-by-case basis.

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“…5 We have used it in patients with atrial or ventricular septal defects or for ventricular septal defect closure in cases of transposition of the great arteries and truncus arteriosus with borderline operability. [6][7][8] It is designed to allow a right-to-left shunt during an episode of pulmonary hypertensive crisis, preventing acute right ventricular dysfunction. It does not allow left-to-right shunting when PA pressure decreases.…”

Section: Discussionmentioning

confidence: 99%