Clinical Analysis Of Left-to-Right Shunt Congenital Heart Disease With Pulmonary Arterial Hypertension In119Cases

Objective:To improve the therapeutic efficacy of left-to-right shunt congenital heart disease with pulmonary arterial hypertension, the investigators conducted a retrospective study on119cases and follow-up.Methods:Totally119cases of left-to-right shunt congenital heart disease with pulmonary arterial hypertension were collected from2005January to2010December, whose clinical information were retrospectively analyzed. The age of the patients varied from3months to15years old, average is42.4±2.8months old. It included74males and45females. All the patients received echocardiogram examination, and part of them received cardiac catheterization to identify the level of the pulmonary hypertension. All the patients received the drugs treatment, and part of the all received interventional therapy or surgical treatment. Regularly follow-up were carried out after the treatment.Results:Among the119cases, there were42cases of ventricular septal defect,8cases of ventricular septal defect combined with atrial septal defect,7cases of atrial septal defect combined with patent ductus arteriosus. There were29cases of atrial septal defect,5cases of atrial septal defect combined with patent ductus arteriosus. There were28cases of patent ductus arteriosus. Among the clinical presentation and signs, frequently upper respiratory infection, tachypnea, cardiac murmur and pulmonary second heart sounds loudly were the most common. The chest X ray showed that the cadiac thoracic ratio varied from0.48to0.72. The electrocardiography showed that most of the children had the right ventrical or double ventrical hypertrophy. All the patients received the echocardiogram examination and the pulmonary artery presure varied from32to102(66.52±11.33)mmHg before treatment. All the patients received internal medicine drugs. There were66children had received cardiac catheterization and1case occured hemolysis one day after the catheterization, finally all of them were cured. There were53cased received surgical operation and49cases were improved. After the operation,1case complicated with infection of incision wound,8cases had upper respiratory infection,1case complicated with pneumonia,8cases had arrhythmia.4cases died because of low cardiac output syndrome and pulmonary hypertension articulo. After the treatment, The pulmonary artery pressure came to the scope from8to90(20.23±7.13)mmHg, P<0.01. There were79cases (66.4%) whose pulmonary artery pressure decreased more than40mmHg. There were17cases of severe pulmonary hypertension, who received surgical operation after the drug treatment. There were14cases (82%) whose pulmonary artery pressure decreased more than20mmHg. There were2 cases had low cardiac output syndrome, and1case occured pulmonary hypertension articulo. The echocardiogram was taken when it was3months,6months and1year after the operation respectively. The difference was not obvious during the early period after the operation (81.3±13.2mmHg). After the discharge, long time follow-up was carried out, and98cases (82.4%) were followed. The follow-up time varied from1month to5years. The cardiac thoracic ratio, chambers size, the function of left heart were all improved compared to the before.Conclusion:(1)It should be diagnosed as early as possible for the left-to-right shunt congenital heart disease with pulmonary arterial hypertension, and choosing the correct indications of interventional or surgical therapy can improve the structure and function of the heart.(2)For the moderate and severe cases, choosing the correct indications of operation can boost the cure rate in some extent.(3)The echocardiogram has the vital role in diagnosis for the congenital heart disease and assessment of pulmonary artery pressure.