Long-term outcome of patients operated for large ventricular septal defects with increased pulmonary vascular resistance

Bhava R.J. Kannan, S. Sivasankaran, Jaganmohan A. Tharakan, Thomas Titus, V. K.Ajith Kumar, Bimal Francis, K. M. Krishnamoorthy, S. Harikrishnan, R. Padmakumar, Krishnakumar Nair

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Abstract

Background: There is a paucity of data regarding the long-term outcome of patients operated for ventricular septal defect with severe pulmonary arterial hypertension and elevated pulmonary vascular resistance. Methods and Results: We evaluated the long-term follow-up results of a selected cohort of patients with nonrestrictive ventricular septal defect and elevated pulmonary vascular resistance (>6 Wood units). Thirty-eight patients, median age 7.5 years (range 6 months-27 years), with nonrestrictive ventricular septal defect with severe pulmonary hypertension were operated between 1985 and 1996 at our institute. Preoperative pulmonary vascular resistance, ratio of pulmonary blood flow to systemic blood flow, and ratio of pulmonary vascular resistance to systemic vascular resistance were 7.63±1.8 Wood units, 1.9±0.48, and 0.41±0.12, respectively. The majority (68.4%) had perimembranous ventricular septal defect. Thirty patients (79%) had a good outcome and were asymptomatic at a mean follow-up of 8.7 years, with significant reduction in pulmonary artery pressures. Eight patients (21%) had a poor outcome, which included 5 immediate postoperative deaths, 1 late death and 2 surviving patients with persistent severe pulmonary arterial hypertension. There was no significant difference regarding hemodynamic parameters at baseline between those who had a good outcome and those who did not. Eleven patients with a preoperative pulmonary blood flow to systemic blood flow ratio of <2:1, who had a good outcome following surgery, underwent repeat catheterization at follow-up. There was a significant reduction in their mean pulmonary vascular resistance (8.03±1.4 v. 4.16±1.6 Wood units, p=0.001) and pulmonary vascular resistance to systemic vascular resistance ratio (0.41±0.12 v. 0.19±0.06, p=0.05). Conclusions: The late results of surgery on this selected group of patients with nonrestrictive ventricular septal defect with high pulmonary vascular resistance are encouraging. Operative correction of the ventricular septal defect should be actively considered in all children presenting with nonrestrictive ventricular septal defect with a significant left-to-right shunt, despite moderately elevated pulmonary vascular resistance. Even among older patients with ventricular septal defect and moderately elevated pulmonary vascular resistance, there is a specific group that does well after operation.

Original languageEnglish
Pages (from-to)161-166
Number of pages6
JournalIndian Heart Journal
Volume55
Issue number2
Publication statusPublished - 01-03-2003

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Ventricular Heart Septal Defects
Vascular Resistance
Pulmonary Hypertension
Lung
Reoperation
Catheterization
Pulmonary Artery
Hemodynamics
Pressure

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Kannan, B. R. J., Sivasankaran, S., Tharakan, J. A., Titus, T., Kumar, V. K. A., Francis, B., ... Nair, K. (2003). Long-term outcome of patients operated for large ventricular septal defects with increased pulmonary vascular resistance. Indian Heart Journal, 55(2), 161-166.
Kannan, Bhava R.J. ; Sivasankaran, S. ; Tharakan, Jaganmohan A. ; Titus, Thomas ; Kumar, V. K.Ajith ; Francis, Bimal ; Krishnamoorthy, K. M. ; Harikrishnan, S. ; Padmakumar, R. ; Nair, Krishnakumar. / Long-term outcome of patients operated for large ventricular septal defects with increased pulmonary vascular resistance. In: Indian Heart Journal. 2003 ; Vol. 55, No. 2. pp. 161-166.
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abstract = "Background: There is a paucity of data regarding the long-term outcome of patients operated for ventricular septal defect with severe pulmonary arterial hypertension and elevated pulmonary vascular resistance. Methods and Results: We evaluated the long-term follow-up results of a selected cohort of patients with nonrestrictive ventricular septal defect and elevated pulmonary vascular resistance (>6 Wood units). Thirty-eight patients, median age 7.5 years (range 6 months-27 years), with nonrestrictive ventricular septal defect with severe pulmonary hypertension were operated between 1985 and 1996 at our institute. Preoperative pulmonary vascular resistance, ratio of pulmonary blood flow to systemic blood flow, and ratio of pulmonary vascular resistance to systemic vascular resistance were 7.63±1.8 Wood units, 1.9±0.48, and 0.41±0.12, respectively. The majority (68.4{\%}) had perimembranous ventricular septal defect. Thirty patients (79{\%}) had a good outcome and were asymptomatic at a mean follow-up of 8.7 years, with significant reduction in pulmonary artery pressures. Eight patients (21{\%}) had a poor outcome, which included 5 immediate postoperative deaths, 1 late death and 2 surviving patients with persistent severe pulmonary arterial hypertension. There was no significant difference regarding hemodynamic parameters at baseline between those who had a good outcome and those who did not. Eleven patients with a preoperative pulmonary blood flow to systemic blood flow ratio of <2:1, who had a good outcome following surgery, underwent repeat catheterization at follow-up. There was a significant reduction in their mean pulmonary vascular resistance (8.03±1.4 v. 4.16±1.6 Wood units, p=0.001) and pulmonary vascular resistance to systemic vascular resistance ratio (0.41±0.12 v. 0.19±0.06, p=0.05). Conclusions: The late results of surgery on this selected group of patients with nonrestrictive ventricular septal defect with high pulmonary vascular resistance are encouraging. Operative correction of the ventricular septal defect should be actively considered in all children presenting with nonrestrictive ventricular septal defect with a significant left-to-right shunt, despite moderately elevated pulmonary vascular resistance. Even among older patients with ventricular septal defect and moderately elevated pulmonary vascular resistance, there is a specific group that does well after operation.",
author = "Kannan, {Bhava R.J.} and S. Sivasankaran and Tharakan, {Jaganmohan A.} and Thomas Titus and Kumar, {V. K.Ajith} and Bimal Francis and Krishnamoorthy, {K. M.} and S. Harikrishnan and R. Padmakumar and Krishnakumar Nair",
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Kannan, BRJ, Sivasankaran, S, Tharakan, JA, Titus, T, Kumar, VKA, Francis, B, Krishnamoorthy, KM, Harikrishnan, S, Padmakumar, R & Nair, K 2003, 'Long-term outcome of patients operated for large ventricular septal defects with increased pulmonary vascular resistance', Indian Heart Journal, vol. 55, no. 2, pp. 161-166.

Long-term outcome of patients operated for large ventricular septal defects with increased pulmonary vascular resistance. / Kannan, Bhava R.J.; Sivasankaran, S.; Tharakan, Jaganmohan A.; Titus, Thomas; Kumar, V. K.Ajith; Francis, Bimal; Krishnamoorthy, K. M.; Harikrishnan, S.; Padmakumar, R.; Nair, Krishnakumar.

In: Indian Heart Journal, Vol. 55, No. 2, 01.03.2003, p. 161-166.

Research output: Contribution to journalArticle

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T1 - Long-term outcome of patients operated for large ventricular septal defects with increased pulmonary vascular resistance

AU - Kannan, Bhava R.J.

AU - Sivasankaran, S.

AU - Tharakan, Jaganmohan A.

AU - Titus, Thomas

AU - Kumar, V. K.Ajith

AU - Francis, Bimal

AU - Krishnamoorthy, K. M.

AU - Harikrishnan, S.

AU - Padmakumar, R.

AU - Nair, Krishnakumar

PY - 2003/3/1

Y1 - 2003/3/1

N2 - Background: There is a paucity of data regarding the long-term outcome of patients operated for ventricular septal defect with severe pulmonary arterial hypertension and elevated pulmonary vascular resistance. Methods and Results: We evaluated the long-term follow-up results of a selected cohort of patients with nonrestrictive ventricular septal defect and elevated pulmonary vascular resistance (>6 Wood units). Thirty-eight patients, median age 7.5 years (range 6 months-27 years), with nonrestrictive ventricular septal defect with severe pulmonary hypertension were operated between 1985 and 1996 at our institute. Preoperative pulmonary vascular resistance, ratio of pulmonary blood flow to systemic blood flow, and ratio of pulmonary vascular resistance to systemic vascular resistance were 7.63±1.8 Wood units, 1.9±0.48, and 0.41±0.12, respectively. The majority (68.4%) had perimembranous ventricular septal defect. Thirty patients (79%) had a good outcome and were asymptomatic at a mean follow-up of 8.7 years, with significant reduction in pulmonary artery pressures. Eight patients (21%) had a poor outcome, which included 5 immediate postoperative deaths, 1 late death and 2 surviving patients with persistent severe pulmonary arterial hypertension. There was no significant difference regarding hemodynamic parameters at baseline between those who had a good outcome and those who did not. Eleven patients with a preoperative pulmonary blood flow to systemic blood flow ratio of <2:1, who had a good outcome following surgery, underwent repeat catheterization at follow-up. There was a significant reduction in their mean pulmonary vascular resistance (8.03±1.4 v. 4.16±1.6 Wood units, p=0.001) and pulmonary vascular resistance to systemic vascular resistance ratio (0.41±0.12 v. 0.19±0.06, p=0.05). Conclusions: The late results of surgery on this selected group of patients with nonrestrictive ventricular septal defect with high pulmonary vascular resistance are encouraging. Operative correction of the ventricular septal defect should be actively considered in all children presenting with nonrestrictive ventricular septal defect with a significant left-to-right shunt, despite moderately elevated pulmonary vascular resistance. Even among older patients with ventricular septal defect and moderately elevated pulmonary vascular resistance, there is a specific group that does well after operation.

AB - Background: There is a paucity of data regarding the long-term outcome of patients operated for ventricular septal defect with severe pulmonary arterial hypertension and elevated pulmonary vascular resistance. Methods and Results: We evaluated the long-term follow-up results of a selected cohort of patients with nonrestrictive ventricular septal defect and elevated pulmonary vascular resistance (>6 Wood units). Thirty-eight patients, median age 7.5 years (range 6 months-27 years), with nonrestrictive ventricular septal defect with severe pulmonary hypertension were operated between 1985 and 1996 at our institute. Preoperative pulmonary vascular resistance, ratio of pulmonary blood flow to systemic blood flow, and ratio of pulmonary vascular resistance to systemic vascular resistance were 7.63±1.8 Wood units, 1.9±0.48, and 0.41±0.12, respectively. The majority (68.4%) had perimembranous ventricular septal defect. Thirty patients (79%) had a good outcome and were asymptomatic at a mean follow-up of 8.7 years, with significant reduction in pulmonary artery pressures. Eight patients (21%) had a poor outcome, which included 5 immediate postoperative deaths, 1 late death and 2 surviving patients with persistent severe pulmonary arterial hypertension. There was no significant difference regarding hemodynamic parameters at baseline between those who had a good outcome and those who did not. Eleven patients with a preoperative pulmonary blood flow to systemic blood flow ratio of <2:1, who had a good outcome following surgery, underwent repeat catheterization at follow-up. There was a significant reduction in their mean pulmonary vascular resistance (8.03±1.4 v. 4.16±1.6 Wood units, p=0.001) and pulmonary vascular resistance to systemic vascular resistance ratio (0.41±0.12 v. 0.19±0.06, p=0.05). Conclusions: The late results of surgery on this selected group of patients with nonrestrictive ventricular septal defect with high pulmonary vascular resistance are encouraging. Operative correction of the ventricular septal defect should be actively considered in all children presenting with nonrestrictive ventricular septal defect with a significant left-to-right shunt, despite moderately elevated pulmonary vascular resistance. Even among older patients with ventricular septal defect and moderately elevated pulmonary vascular resistance, there is a specific group that does well after operation.

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Kannan BRJ, Sivasankaran S, Tharakan JA, Titus T, Kumar VKA, Francis B et al. Long-term outcome of patients operated for large ventricular septal defects with increased pulmonary vascular resistance. Indian Heart Journal. 2003 Mar 1;55(2):161-166.