Surgical Treatment Of Left-To-Right Shunt Congenital Heart Disease With Pulmonary Arterial Hypertension In 210 Cases

Objective:To analyze the clinical characteristics and the operation treatment of left-to-right shunt congenital heart disease(CHD) with pulmonary arterial hypertension(PAH).Methods:Totally 210 cases of left-to-right CHD with PAH were collected from September 2012 to September 2013,whose clinical characteristics were retrospectively analyzed and divided into the intervention group (86 cases) and the surgical group (124cases) according to different therapeutic methods. The similarities and differences of clinical features, operation time, volume of blood transfusion and curative effect between the two groups were analyzed.Results:Among the clinical manifestations and signs, recurrent respiratory tract infections, feeding interruption,different levels’ malnutrition, cardiac murmur and pulmonary second heart sounds loudly were the most common..The children with cyanosis, severe malnutrition or pulmonary second heart sounds loudly in the surgical group were more than that in the intervention group. The children with growth and development backwardness in the intervention group were more than that in the surgical group (P<0.05).The comparison of the results of chest X ray(mainly showed that multiple pulmonary blood and increased heart shadow)and electrocardiogram (mainly showed that double ventricular hypertrophy and right bundle branch block) between the intervention group and the surgical group mostly had no statistical significance (P>0.05).The right ventricular hypertrophy occurred more often in the surgical group than in the intervention group (P<0.05).The volume of blood transfusion, intensive care unit (ICU) care duration postoperative mechanical ventilation duration, operation time,hospitalized duration were significantly longer in surgical group than in intervention group (P<0.05).The operation success rate of the two groups were as high as 97.67% and 97.58%, respectively. And there was no statistical significance between the two groups(P>0.05).The pulmonary arterial systolic pressure(PASP) in the two groups were significantly decreased after operation (P< 0.05).Conclusions:CHD with PAH is not easy to early diagnosis. The detection of echocardiography and PASP will do great help in the regularly follow-up in outpatient service. For the children who conform to the interventional treatment for indications can be preferred intervention treatment. But for the children who are low age and with cyanosis or severe malnutrition or pulmonary second heart sounds loudly or the right ventricular hypertrophy showed in electrocardiogram or larger diameter of the defect or higher PASP, surgical treatment should be chose as soon as possible.