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

Abstract

OBJECTIVE:

The purpose of the present study was to study the midterm hemodynamic outcomes of unidirectional valved patch closure of ventricular septal defects (VSDs) in patients with VSD and pulmonary arterial hypertension (PAH).

METHODS:

From January 2006 to January 2012, 20 patients with VSD with PAH and a pulmonary vascular resistance index >8 Wood units underwent VSD closure with a unidirectional valved patch using the technique previously described by us. Of these, 13 patients agreed to follow-up cardiac catheterization and were studied at a mean follow-up of 34.7 ± 18.6 months (range, 2-56). The mean age of these 13 patients was 8.5 ± 4.4 years (range, 2-19; median, 9), and the mean preoperative systemic saturation was 94.1% ± 3.4% (range, 87-99; median, 95.0) The mean preoperative pulmonary artery systolic pressure was 96.2 ± 13.6 mm Hg (range, 75-115; median, 103.0), and the mean preoperative pulmonary vascular resistance index was 10.0 ± 2.1 Wood units (range, 8.0-15.1; median, 9.3).

RESULTS:

At follow-up cardiac catheterization, the mean systemic saturation had increased to 98.92%. The pulmonary vascular resistance index had decreased significantly to 5.8 ± 2.1 Wood units (P = .02). A significant decrease was seen in the pulmonary artery systolic, diastolic, and mean pressures (P = .000), and none of the patients had severe PAH. No patients died, and all patients were in New York Heart Association class I.

CONCLUSIONS:

Unidirectional valved patch closure of VSD is a promising technique for patients with a large VSD and severe PAH. It had a favorable effect on the immediate, early, and midterm clinical outcomes and hemodynamic parameters.

• Authors: Sachin Talwar, Vikas Kumar Keshri, Shiv Kumar Choudhary, Saurabh Kumar Gupta, Sivasubramanian Ramakrishnan, Anita Saxena, Shyam Sunder Kothari, Rajnish Juneja, Guresh Kumar, Balram Airan
• Journal: The Journal of thoracic and cardiovascular surgery (J Thorac Cardiovasc Surg) Vol. 148 Issue 6 Pg. 2570-5 (Dec 2014) ISSN: 1097-685X [Electronic] United States
• PMID: 24332111 (Publication Type: Journal Article)
• Copyright: Copyright © 2014 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Topics

• Adolescent
• Cardiac Catheterization
• Cardiac Surgical Procedures
• Child
• Child, Preschool
• Echocardiography
• Electrocardiography
• Female
• Heart Septal Defects, Ventricular (complications, diagnosis, physiopathology, surgery)
• Hemodynamics
• Humans
• Hypertension, Pulmonary (complications, diagnosis, physiopathology)
• Male
• Severity of Illness Index
• Time Factors
• Treatment Outcome
• Young Adult