%0 Journal Article
%T Left-to-Right Shunt with Congenital Heart Disease: Single Center Experience
%A Ayhan Cevik
%A Rana Olgunturk
%A Serdar Kula
%A Berna Saylan
%A Ayhan Pektas
%A Deniz Oguz
%A Sedef Tunaoglu
%J ISRN Cardiology
%D 2013
%R 10.1155/2013/301617
%X Objective. The objective of this study was to determine the frequency of pulmonary arterial hypertension (PAH) in congenital heart disease (CHD) with an isolated, large left-to-right shunt and to indicate the factors in the development of PAH. Methods. The pressure measurements in the cardiac chambers and the calculations based on the FickĄ¯s principle were compared among 3 separate groups of patients, respectively, with PAH, with hyperkinetic pulmonary hypertension (HPH), and with neither PAH nor HPH. Results. PAH was diagnosed in 30 (12.3%) patients, HPH in 35 (14.4%), while 177 (73.1%) were free of either. The highest risk for the development of PAH was found in the presence of perimembranous ventricular septal defect. A statistically significant difference was seen among these groups as to their left atrial pressure ( ) and the mean pulmonary arterial pressure (PAPmean; ). While a correlation was present between RpI on one hand and age on the other ( ), a multiple linear regression could not evidence any correlation among age ( ), gender ( ). Conclusion. Our findings do not allow establishing a correlation between the duration of the high pulmonary flow and pulmonary vascular resistance increase or PAH development in isolated left-to-right shunts with congenital heart diseases. 1. Introduction In all congenital heart diseases (CHD) with unrestricted left-to-right shunt, high pulmonary arterial flow can present together with pulmonary arterial hypertension (PAH); the grade of pulmonary vascular lesions is, however, important in the development of pulmonary vascular lesions [1]. The most important, in frequency, of the conditions leading to PAH in CHD are those which include left-to-right shunts [2]. While estimating the risk of PAH is of primordial importance for pediatric patients with a left-to-right shunt, there is no consensus or established guideline to date [3]. How is the risk of developing PAH in cases of CHD with left-to-right shunt characterized, and which are the determining factors? Several sets of criteria and practices have been developed regarding surgical indication and prognosis; the accepted gold standard in diagnosis is right heart catheterization [4]. This invasive technique, however, does not lend itself to easy, repeated use. Additionally, the calculation of indices for cardiac catheterization based on the FickĄ¯s principle does not necessarily correspond to the reality. Stimuli such as increased pulmonary arterial flow and pressure lead to an imbalance in vascular tonus and to vascular remodeling [5]. The degree of pulmonary
%U http://www.hindawi.com/journals/isrn.cardiology/2013/301617/