TREATMENT OF CONGENITAL HEART DISEASE WITH PULMONARY HYPERTENSION DURING PERI-OPERATION / 解放军医学杂志

ABSTRACT

Forty-seven patients with congenital heart disease and pulmonary hypertension were treated surgically. Among them, 31 were male and 16 female. The age ranged from 2 to 47(13. 7? 11. 2) years. Gongenital heart abnormalities included ventricular septal defect (VSD) in 20, huge atrial septal defect (ASD) in 1, VSD+ASI) in 12, VSD with patent ductus arteriosus (PDA) in 6, endocardial cushion in 2, VSD with aortopulmonary septal defect (APSD) in 1, double outlet right ventricle with PDA in 1 and total anomalous pulmonary venous connection in 1. Right heart catheterization was performed in 15 cases. The mean pulmonary artery pressure was (73 ? 24)mmHg, total pulmonary resistance was (78. 0 ?61. 2)kPa/(L/s). There were 7 cases examined in operation. Their mean pulmonary artery pressure was (55?13)mmHg. The others were examined by echocardiography. The mean pulmonary artery pressure was (49?15)mmHg. All patients were treated pre-op-eratively with oxygen inhalation therapy, hyperbaric oxygenation, prostaglandin E1 , respectively according to the degree of pulmonary hypertension. During cardiopulmonary bypass, pulmonary artery perfusion was performed with protective solution containing aprotinin for lung protection. Vasoactive drugs were routinely administrated postoperatively. There were 2 operative deaths with hospital mortality rate of 4. 3%. The cause of deaths was severe low cardiac output syndrome. The postoperative morbidity rate was 4. 3%. Our conclusion is proper peri-operative management could reduce post-operative mortality and morbidity for congenital heart disease with pulmonary hypertension.