01 March 2017 by Dr. Prashant Bobhate

Diastolic pressure gradient predicts operability in children with post tricuspid shunt and pulmonary arterial hypertension

Introduction

Persistence or recurrence of pulmonary hypertension (PH) is a major cause of mortality and morbidity after closure of post tricuspid shunt with borderline operability. We sought to identify parameters at cardiac catheterisation which could possibly predict persistence of PH two years after surgery.

Methods

This is a retrospective study. We studied consecutive patients of ventricular septal defect who underwent cardiac catheterization to determine operability and underwent closure of the shunt between 2011 and 2014. Patients with follow up of at least 2 years were included in the study.  Mean PA pressure of > 25 mm Hg on cardiac cath or peak systolic pressure of > 40 mm Hg on echocardiogram was used to define PH at follow up. The subjects were divided into two groups depending on the presence (Group 1) or absence of PH (Group 2). Both the groups were compared for preoperative cardiac cath parameters. DPG was defined as the difference between diastolic PA pressures and mean PA wedge pressures.

Results

A total of 17 patients (7 M); 11 in Group 1 were included in the study. The median age was 5.6 years (1 to 20 years) and the median weight 12.4 kg (6.3 to 39.4 kg). Mean PA pressure in group 1 was 58.1 + 10.6 mm Hg and in group 2 was 37.7 + 16 mm Hg (P = 0.01), The Rp/Rs and Qp/Qs ratio were comparable in both the groups. (P value 0.4 and 0.9 respectively). The diastolic PA pressures in group 1 were 37.6 ± 8.74 and in group 2 were 22.14 ± 8.27 (p = 0.002). The DPG in group 1 was 27.8 ± 9.22 mmHg and in group 2 was 11.28 ± 6.67 mmHg (p = 0.001). DPG emerged as the most sensitive and specific marker to predict the presence of postoperative PH on receiver operator characteristic curve.

Conclusion

Higher DPG was a more sensitive and specific marker to predict post-operative PH. If validated further it may emerge as a very important marker to determine operability.

Key Contributors

Dr Prashant Bobhate, Dr Sylvia Colaco, Dr Tanuja Karande, Dr Snehal Kulkarni. Children’s heart center, Kokilaben Dhirubai Ambani Hospital, four Bunglows, Andheri west, Mumbai 400053, India.


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