Parameters associated with outcome in pediatric patients with congenital heart disease and pulmonary hypertension subjected to combined vasodilator and surgical treatments

Author(s)

Thomaz, Ana Maria ^[1] ; Kajita, Luiz J. ^[1] ; Aiello, Vera D. ^[1] ; Zorzanelli, Leina ^[1] ; Galas, Filomena Regina B. G. ^[1] ; Machado, Cleide G. ^[2] ; Barbero-Marcial, Miguel ^[1] ; Jatene, Marcelo B. ^[1] ; Rabinovitch, Marlene ^[3] ; Lopes, Antonio Augusto ^[1]

Affiliation

^[1] Univ Sao Paulo, Heart Inst, Sch Med, Sao Paulo - Brazil

^[2] Univ Sao Paulo, Hosp Clin, Sch Med, Sao Paulo - Brazil

^[3] Stanford Univ, Sch Med, Stanford, CA - USA

• Document type: Journal article
• Source: PULMONARY CIRCULATION; v. 9, n. 3 JUL 2019.
• Web of Science Citations: 0

Abstract

Management of pediatric pulmonary hypertension associated with congenital heart disease (PHT-CHD) is challenging. Some patients have persistently elevated pulmonary artery pressure (PAP) after cardiac surgery, an undesired condition that is difficult to predict. We investigated the value of clinical, hemodynamic, and histopathological data in predicting the outcome in a prospective cohort. Patients with PHT-CHD received sildenafil orally pre- and postoperatively for six months and then were subjected to a catheter study. Thirty-three patients were enrolled (age range = 4.6-37.0 months). Pulmonary vascular resistance (PVR) was 4.9 (range = 3.9-7.2) Wood units x m(2) (median with IQR). Twenty-two patients had a >= 20% decrease in PVR and pulmonary-to-systemic vascular resistance ratio (PVR/SVR) in response to inhaled nitric oxide (NO). The response was directly related to the degree of medial hypertrophy of pulmonary arterioles (P < 0.05) (morphometric analysis, intraoperative lung biopsy). Subsequently, five of the non-responders had a >= 30% increase in pulmonary blood flow in response to sildenafil (3.0 {[}2.0-4.0] mg/kg/day). Six months after surgery, PAP and PVR were significantly lower (P < 0.001 vs. baseline), even in seven patients with Heath-Edwards grade III/IV pulmonary vascular lesions (P = 0.018), but still abnormal in 12 individuals (>25 mmHg and >3.0 U x m(2), respectively). A preoperative PVR/SVR of >= 24% during NO inhalation and a wall thickness of arteries accompanying respiratory bronchioli of >= 4.7 (Z score) were identified, respectively, as risk and protection factors for abnormal postoperative hemodynamics (hazard ratio {[}95% CI] = 1.09 {[}1.01-1.18], P = 0.036; and 0.69 {[}0.49-0.98], P = 0.040, respectively). Thus, in PHT-CHD patients receiving oral sildenafil pre- and post-surgical repair of cardiac lesions, mid-term postoperative outcome is predictable to some extent. (AU)

• FAPESP's process: 11/09341-0 - Combined clinical and surgical approaches to congenital heart disease associated with pulmonary arterial hypertension - possible role of genetic and inflammatory markers
• Grantee: Antonio Augusto Barbosa Lopes
• Support Opportunities: Regular Research Grants