Analysis of operability in patients with severe pulmonary hypertension related to congenital heart disease
WANG Xiao-feng
GU Hong
ZHANG Chen
WU Bang-jun
GUO Bao-jing
ZHANG Hui
CHENG Pei
LIU Ying-long
Abstract：Objective To analyze the operability in patients with severe pulmonary hypertension (PAH)related to congenial heart disease (CHD).Methods From June 2006 to October 2010,the clinical data of 30 patients who experienced total rerpair were retrospectively analyzed.All of them had preoperative cardiac catheterization and acute pulmonary vasodilator testing with 100％ oxygen and inhaled Iloprost respectively.According to the postoperative recovery (whether postoperative mean pulmonary pressure ≥25 mm Hg),patients were separated into two groups:normal pulmonary pressure group and PAH group.The preoperative clinical data between the two groups and the receiver operating characteristic curve were analyzed to find the data related to the operability.Results There was no deaths after operations.Group 1 (postoperative mean pulmonary pressure ＜ 25 mm Hg)contained 12 patients and group 2 (postoperative mean pulmonary pressure ≥25 mm Hg) contained 18 patients.Between the two groups,the cardiothoracic ratio (CTR) [ (0.67 ± 0.06) vs (0.55 ± 0.06) ] on chest X-ray; pulmonary vascular resistance index (PVRi) [ (7.6 ±3.2)wood unit/m2 vs ( 13.0 ±4.5)wood unit/m2] at baseline; pulmonary/systemic circulation blood flow ratio(Qp/Qs) and PVRi at acute pulmonary vasodilator testing with 100％ oxygen [ Qp/Qs:5.6 ± 3.5 vs2.7 ± 0.8,PVRi:( 3.0 ± 1.8 ) wood unit/m2 vs ( 6.4 ± 2.2) wood unit/m2 ] ; Qp/Qs ; PVRi and pulmonary/systemic circulation resistance ratio(Rp/Rs) at vasodilator testing with inhaled iloprost [ Qp/Qs:4.1 ± 2.4 vs 2.0 ± 1.3,PVRi:(4.3 ±3.0) wood unit/m2 vs (8.3 ±3.1 )wood unit/m2,Rp/Rs:0.2 ±0.2 vs 0.4 ±0.2]all showed statistical significances (P ＜ 0.05).The ROC curve indicated that CTR was most sensitive and PRVi at acute pulmonary vasodilator testing with 100％ oxygenand inhaled iloprost was most accurate. CTR more than 0.615,PVRi at vasodilator testing with 100％ oxygen less than 4.22 wood unit/m2,PVRi at vasodilator testing with inhaled iloprost less than 4.915 wood unit · m2 may predict good short term postoperative prognosis.Conclusion The CTR and PVRi at acute pulmonary vasodilator testing with 100％ oxygen and inhaled iloprost help analyze the operability in patients with severe PAH related to CHD.
Keywords：Heart defectcongenitalHypertensionpulmonaryHeart catheterizationSurgery
Publication Date：2012-01-01
Online Publishing Date：2026-09-14(First online date of this platform, not the publication date of the document)