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Open AccessArticle

Residual Pulmonary Hypertension More than 20 Years after Repair of Shunt Lesions

1
Centre of Cardiology and Angiology, Vilnius University, LT 08661 Vilnius, Lithuania
2
Faculty of Medicine, Vilnius University, LT 03101 Vilnius, Lithuania
3
Department of Cardiology, Erasmus MC University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
4
Centre of Heart and Chest Surgery, Vilnius University, LT 08661 Vilnius, Lithuania
*
Author to whom correspondence should be addressed.
Medicina 2020, 56(6), 297; https://doi.org/10.3390/medicina56060297
Received: 8 May 2020 / Revised: 14 June 2020 / Accepted: 15 June 2020 / Published: 16 June 2020
(This article belongs to the Section Cardiology)
Background and Objectives: After successful surgical repair of a congenital shunt lesion, pulmonary hypertension (PH) often disappears. However, PH can persist long-term after the closure. This study aimed to assess the prevalence of PH long-term after surgical repair of congenital heart disease (CHD), and to evaluate the outcomes and preoperative factors related to residual PH. Materials and Methods: In this retrospective cohort study, we reviewed patients who underwent right heart catheterisation in Vilnius University Hospital Santaros Klinikos during the period of 1985–2007. Among 4118 right heart catheterisations performed, 160 patients underwent congenital systemic-to-pulmonary shunt repair at a young age (<18 years) and had pre-operative PH. Half of the patients were foreigners whose follow-up data were unavailable. Eventually, 88 patients with available follow-up data were included in this study. Results: The median age at diagnosis of CHD with PH was 0.8 (0.6–3.0) and 1.1 (0.6–3.9) years at surgery (50% females). Residual PH was assessed 9.5 years after surgery and observed in 30.7% (n = 27) of the patients. It was associated with having more than one shunt (44.4% (n = 12), p = 0.016) and higher median pulmonary vascular resistance (3.4 (2.5–6.5) vs. 2.2 (1.0–3.7), p = 0.035) at baseline. After a median follow-up of 21 (15–24) years, 9.1% of the patients were deceased. Kaplan–Meier survival analysis revealed significantly higher mortality in the residual PH group (p = 0.035). Conclusions: Residual PH affects a significant proportion of patients after surgical repair of a shunt lesion and is associated with worse long-term outcome. View Full-Text
Keywords: pulmonary hypertension; congenital heart disease; surgery; right heart catheterisation pulmonary hypertension; congenital heart disease; surgery; right heart catheterisation
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Jančauskaitė, D.; Rudienė, V.; Jakutis, G.; Geenen, L.W.; Roos-Hesselink, J.W.; Gumbienė, L. Residual Pulmonary Hypertension More than 20 Years after Repair of Shunt Lesions. Medicina 2020, 56, 297.

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