Back to Search
Start Over
A case of a middle-aged patient with a ventricular septal defect complicated by severe pulmonary hypertension-stepwise surgical repair with pulmonary vasodilators
- Source :
- Journal of Cardiology Cases
- Publication Year :
- 2021
- Publisher :
- Elsevier BV, 2021.
-
Abstract
- We report a case of ventricular septal defect (VSD) in which we attempted to treat pulmonary arterial hypertension (PAH) with the goal of VSD closure in an adult with suspected Eisenmenger syndrome in childhood. Four years previously (age 41 years), she was referred to our department due to repeated hemoptysis requiring further treatment of PAH. We started combination therapy with several pulmonary vasodilators. Two years later, her pulmonary vascular resistance (PVR) was improved but still not at the level where VSD closure was possible. To control the increased PA flow resulting from intensive PAH treatment and to reduce the risk of hemoptysis, we performed pulmonary artery banding (PAB). As the risk of hemoptysis decreased, a prostacyclin analog was introduced, and the dose was increased. More than 1 year after PAB, active vasoactivity testing became positive, suggesting that the pulmonary vascular lesion was now “reversible”. We performed VSD closure and atrial septal defect creation even though her PVR was still high. After the operation, her exercise capacity was remarkably improved. We suggest that stepwise surgical repair with pulmonary vasodilators is an important treatment option for select patients with VSD with severe PAH.
- Subjects :
- congenital, hereditary, and neonatal diseases and abnormalities
medicine.medical_specialty
Combination therapy
Case Report
Prostacyclin
Ventricular septal defect
030204 cardiovascular system & hematology
Pulmonary arterial hypertension
Pulmonary artery banding
03 medical and health sciences
0302 clinical medicine
Internal medicine
Medicine
030212 general & internal medicine
Surgical repair
business.industry
medicine.disease
Pulmonary hypertension
medicine.anatomical_structure
Treat-and-repair strategy
Eisenmenger syndrome
Vascular resistance
Cardiology
Cardiology and Cardiovascular Medicine
business
Pulmonary vasodilators
medicine.drug
Subjects
Details
- ISSN :
- 18785409
- Volume :
- 24
- Database :
- OpenAIRE
- Journal :
- Journal of Cardiology Cases
- Accession number :
- edsair.doi.dedup.....89ec043723d778995ad13f2e286944ef