Abstract
Introduction. Until recently, surgical treatment of ventricular septal defects (VSD) with Eisenmenger syndrome was considered as impossibility. Due to advancement in the cardiac surgery, anesthesiology and pharmacology, indications for surgical management of ventricular septal defects and pulmonary hypertension (PH) are continuously expanding. There are some reports both about simultaneous radical correction and two-stage correction with palliative pulmonary artery (PA) narrowing in the first stage. The approach of two-stage surgical management of VSD with Eisenmenger syndrome has not been developed yet.
Material and methods. The first stage of surgical management of VSD with Eisenmenger syndrome (narrowing of PA with lung biopsy) was performed in 44 patients aged 5.8±0.6 years, the second stage (radical correction) – in 30 (68.2%) of them. In 14 (31.8%) patients after PA narrowing, radical correction was impossible due to high residual PH and/or sclerotic changes in pulmonary vessels. The indications for each correction stage were determined on the basis of the catheterization of cardiac chambers and invasive pressure monitoring in the PA (IPAPM). Morphological changes in biopsy specimens of the pulmonary vessels were evaluated by Heath–Edwards classification and mean relative medial thickness of pulmonary vessels.
Results. In the early postoperative period after PA narrowing, 3 patients (6.8%) have died with residual PH; in the late postoperative period after PA narrowing, 30 patients underwent radical correction without any deaths. In 14 patients, radical correction was not possible due to high residual PH and / or sclerotic changes in pulmonary vessels.
Conclusion. Indications for surgery in patients with VSD and Eisenmenger syndrome should be based on IPAPM data. Radical correction in VSD with Eisenmenger syndrome is advisable to perform after PA narrowing. If VSD patients had IV stage morphological changes according to Heath- Edwards classification, PH regression is possible both in early and late postoperative periods.
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