Surgical indication in patients with congenital cardiac defects assessed by open lung biopsyfindings:the result of surgical repair in a patient with atrial septal defect and pulmonary hypertension Shumpei Okubo 1 , Motoko Masuda 1 , Masahiro Naito 1 , Norifumi Nakanishi 1 , Yoshikazu Obayashi 1 , Takeyoshi Kunieda 1 , Takao Yoshioka 2 , Chikao Yutani 3 , Makoto Takamiya 4 , Yoshiharu Koh 5 , Yasuaki Naito 5 1Department of Medicine, National Cardiovascular Center 2Research Institute, National Cardiovascular Center 3Department of Pathology, National Cardiovascular Center 4Department of Radiology, National Cardiovascular Center 5Department of Surgery, National Cardiovascular Center pp.897-900
Published Date 1987/8/15
DOI https://doi.org/10.11477/mf.1404205111
  • Abstract
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The evaluation of pulmonary vascular obstructive disease (PVOD) by lung biopsy specimens are established as useful adjunctive means in the assess-ment of operability in patients with congenital cardiac defects. We experienced a case with atrial septal defect, and her pulmonary arterial mean pres-sure (PAm), pulmonary to systemic flow ratio (Qp/ Qs), pulmonary vascular resistance (Rp), and pulmo-nary to systemic resistance ratio (Rp/Rs) were 51 mmHg, 1.25, 10.2 U, and O.46 respectively. Lung biopsy revealed Heath-Edwards Grade 4 PVOD (ple-xiform lesions). She was successfully operated upon with subsequent improvement in subjective sympto-ms, hypoxemia, cardiomegaly, and ECG evidence of right ventricular overload. Cardiac catheterization one month after the operation showed that the PAm, Rp, Rp/Rs were 38 mmHg, 5. 2 U, O. 32 respectively. The hemodynamic data two years later were essen-tially unchanged. Although the presence of plexi-form lesions are generally believed to indicate that the patients are inoperable, our experience (and some others) suggest that there may be operative indications even in the presence of advanced PVOD in patients with congenital cardiac defects.

Copyright © 1987, Igaku-Shoin Ltd. All rights reserved.


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