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Congenital Heart Disease Having Left to Right Shunts Combined with Pulmonary Hypertension;Preoperative and Postoperative Management Shingo Kasahara 1 1Department of Cardiovascular Surgery, Okayama University Keyword: congenital heart disease , pulmonary hypertension , treat and repair pp.789-794
Published Date 2020/9/20
DOI https://doi.org/10.15106/j_kyobu73_789
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A large population of patients with congenital heart disease with untreated systemic to pulmonary shunts (left to right shunts) will develop pulmonary arterial hypertension (PAH). There are 2 different statuses of an increase in pulmonary arterial pressure. One is high resistance due to high pulmonary blood flow (high flow with high resistance), another one is low pulmonary flow due to high resistance (low flow with high resistance). Chronic large left-to-right shunt induced severe pulmonary vascular disease and pulmonary hypertension. This was then subsequence of low pulmonary blood flow with high pulmonary vascular resistance. We have to avoid this situation and have to do intervention within the pulmonary vascular reactivity has been left. For this reason, preoperative treatment for avoidance of high flow, appropriate timing of interventions and postoperative various managements are important factors as aiming of low pulmonary resistance in this group. Recent advances in PAH-specific drugs have dramatically changed the therapeutic strategy for PAH. A strategy that includes “treatment” with PAH-specific drugs initially and then “repair” by closure of the cardiac defect (i.e. “treat and repair”) was devised, and has been attempted, in patients with PAH associated with a cardiac defect.


© Nankodo Co., Ltd., 2020

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電子版ISSN 2432-9436 印刷版ISSN 0021-5252 南江堂

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