Assessment of operability of congenital cardiac shunts with increased pulmonary vascular resistance.

Patients with large left to right shunts as a result of congenital heart disease can develop changes in pulmonary vasculature that are initially reversible. It is critical in these patients to determine whether closure of the defect would reverse some of the changes in the pulmonary vasculature. A comprehensive clinical and noninvasive evaluation often allows classification in the extremes of the spectrum, but for borderline situations, cardiac catheterization is traditionally undertaken. It is important to obtain invasive data meticulously and efficiently recognizing that the numbers only offer a snapshot and may not be representative of the usual physiologic state of the patient. There are, in addition, several caveats that need to be considered while calculating flows and resistances in these patients. Currently a holistic approach that combines clinical, noninvasive, and invasive data may be the only realistic way of making a decision regarding operability in this challenging group of patients with shunt lesions and elevated pulmonary vascular resistance. Copyright 2008 Wiley-Liss, Inc.