BACKGROUND: A non-restrictive ventricular septal defect (VSD) can cause intracardiac left to right shunt, which leads to increased pulmonary vascular resistance (PVR) and pulmonary hypertension causes bi-directional or even right-left shunt, namely the Eisenmenger's syndrome. For patients with non-restrictive VSD with severe pulmonary hypertension at stage of near or to be Eisenmenger's syndrome, traditional VSD repair carries high mortality and poor prognosis. Recently, targeted drug therapy was used to decrease pulmonary circulation resistance in these patients before they receive defect repair surgery, namely "treat and repair" strategy, however, there is few reports about the midterm result of this strategy in adults with non-restrictive VSD with severe pulmonary hypertension at stage of near or to be Eisenmenger's syndrome. METHODS: In this study, we used this strategy to treat 41 adult VSD patients who received bosentan as the targeted therapy to decrease their PVR before and after repair surgery. RESULTS: A total of 39 patients were followed up for an average of 37 months. None of the patients died during follow-up. Among them, 36 cases continued targeted drug therapy, whose mean pulmonary artery pressure (mPAP) was significantly reduced, including 31 cases with mPAP <50 mmHg, and the valve of tap hole was closed. Besides, the SpO2 was significantly elevated. CONCLUSIONS: These results demonstrated that "treat-and-repair" strategy may be a viable approach for the adults with non-restrictive VSD with severe pulmonary hypertension at stage of near or to be Eisenmenger's syndrome.
BACKGROUND: A non-restrictive ventricular septal defect (VSD) can cause intracardiac left to right shunt, which leads to increased pulmonary vascular resistance (PVR) and pulmonary hypertension causes bi-directional or even right-left shunt, namely the Eisenmenger's syndrome. For patients with non-restrictive VSD with severe pulmonary hypertension at stage of near or to be Eisenmenger's syndrome, traditional VSD repair carries high mortality and poor prognosis. Recently, targeted drug therapy was used to decrease pulmonary circulation resistance in these patients before they receive defect repair surgery, namely "treat and repair" strategy, however, there is few reports about the midterm result of this strategy in adults with non-restrictive VSD with severe pulmonary hypertension at stage of near or to be Eisenmenger's syndrome. METHODS: In this study, we used this strategy to treat 41 adult VSD patients who received bosentan as the targeted therapy to decrease their PVR before and after repair surgery. RESULTS: A total of 39 patients were followed up for an average of 37 months. None of the patients died during follow-up. Among them, 36 cases continued targeted drug therapy, whose mean pulmonary artery pressure (mPAP) was significantly reduced, including 31 cases with mPAP <50 mmHg, and the valve of tap hole was closed. Besides, the SpO2 was significantly elevated. CONCLUSIONS: These results demonstrated that "treat-and-repair" strategy may be a viable approach for the adults with non-restrictive VSD with severe pulmonary hypertension at stage of near or to be Eisenmenger's syndrome.
Authors: Helmut Baumgartner; Philipp Bonhoeffer; Natasja M S De Groot; Fokko de Haan; John Erik Deanfield; Nazzareno Galie; Michael A Gatzoulis; Christa Gohlke-Baerwolf; Harald Kaemmerer; Philip Kilner; Folkert Meijboom; Barbara J M Mulder; Erwin Oechslin; Jose M Oliver; Alain Serraf; Andras Szatmari; Erik Thaulow; Pascal R Vouhe; Edmond Walma Journal: Eur Heart J Date: 2010-08-27 Impact factor: 29.983
Authors: Vallerie V McLaughlin; Ronald J Oudiz; Adaani Frost; Victor F Tapson; Srinivas Murali; Richard N Channick; David B Badesch; Robyn J Barst; Henry H Hsu; Lewis J Rubin Journal: Am J Respir Crit Care Med Date: 2006-08-31 Impact factor: 21.405
Authors: W M Novick; A T Gurbuz; D C Watson; V V Lazorishinets; A N Perepeka; I Malcic; B Marinovic; B S Alpert; T G DiSessa Journal: Ann Thorac Surg Date: 1998-11 Impact factor: 4.330
Authors: Horst Olschewski; Gerald Simonneau; Nazzareno Galiè; Timothy Higenbottam; Robert Naeije; Lewis J Rubin; Sylvia Nikkho; Rudolf Speich; Marius M Hoeper; Jürgen Behr; Jörg Winkler; Olivier Sitbon; Wladimir Popov; H Ardeschir Ghofrani; Alessandra Manes; David G Kiely; Ralph Ewert; Andreas Meyer; Paul A Corris; Marion Delcroix; Miguel Gomez-Sanchez; Harald Siedentop; Werner Seeger Journal: N Engl J Med Date: 2002-08-01 Impact factor: 91.245