Abstract
Criteria used for estimation of surgical risk in children with CHD and PH have been controversial. The clinical, hemodynamic and angiographic data were analised in 23 candidates for surgical treatment. The data were scored as follows: Clinical grade 1, 2 or 3 according to signs of pronounced, mild or absent pulmonary congestion and left ventricular overload. Hemodynamics: 1- pulmonary to systemic resistance ratio PR/SR less than 0.5; 2- PR/SR≥0.5 with a greater than 30% decrease in PR after vasodilators; 3- PR/SR≥0.5, no significant vasodilation. Pulmonary wedge angiography: 1- mild dilatation of arteries, normal or increased capilary haze; 2- difuse tortuosity of muscular arteries and decreased background haze; 3- accentuated tortuosity, arterial retaining of contrast material, sparse or absent capilary network. An optimistic opinion was established for mean of scores equal to or less than 2.0. The data were compared with histopathological findings wich were considered advanced if a difuse grade III (Hearth-Edwards) or an alveolar/artery ratio≥12:1 were observed. The results were in accordance in 16 patients (P = 0.04). Twenty children underwent corrective or paliative surgery. Only 12 patients with an optimistic result (mean of scores) underwent a corrective procedure. One child died on the postoperative period as a consequence of infectious disease, not related to pulmonary vascular problems. On the basis of these results, the scored analysis of multiple data was considered a safe method for evaluation of surgical risk in patients with congenital heart defects and pulmonary hypertension.
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Lopes, A., Aiello, V., Ratti, M. et al. SYSTEMATICAL APPROACH TO PULMONARY HEPERTENSION (PH) IN CHILDREN WITH CONGENITAL HEART DEFECTS (CHD). Pediatr Res 22, 368 (1987). https://doi.org/10.1203/00006450-198709000-00026
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DOI: https://doi.org/10.1203/00006450-198709000-00026