الفهرس 
Congenital heart disease with left to right shuntOnly 14 pages are availabe for public view
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Abstract
ABSTRACT
Background; Pulmonary arterial hypertension (PAH) is defined as an increase in mean pulmonary arterial pressure ≥ 25 mmHg at rest as assessed by right heart catheterization. PAH is a relatively common complication of congenital heart disease (CHD). While invasive assessment of hemodynamics in the catheterization is the gold standard for diagnosing PAH in children, transthoracic echocardiography (TTE) serves as the initial diagnostic tool as misinterpretation of TTE variables can lead to delayed diagnosis and therapy.
Aim and objectives; To compare the directly measured intra-operative PAP to preoperative measurement of PAP by transthoracic echocardiography. To assess the impact of pre-operative echocardiographic findings of PAH on surgical decision and post-operative outcome.
Subjects and methods; This was an observational cross-sectional study that was conducted on 22 infants and children aged from 1 month to 5 years old diagnosed with congenital heart disease with left to right shunt: {atrial septal defect (ASD) or ventricular septal defect (VSD)} referred for surgical intervention in Cardiothoracic Academy, Ain Shams University. Patients were needed to detect pre-operative and post-operative assessment of pulmonary artery pressure using trans-thoracic echocardiography and intra-operative direct assessment of pulmonary artery pressure using direct catheterization.
Result; In this study, before repair, the mean pulmonary artery pressure measured by TTE was (34.27 ± 5.64) mmHg, significantly lower than the corresponding direct catheterization measurement (53.09 ± 10.93) mmHg (p < 0.001, highly significant). After repair, the mean pulmonary artery pressure decreased substantially to (15.77 ± 4.69) mmHg, signifying a successful intervention (p < 0.001, highly significant). There was statically significant positive correlation between hospital length of stay and pulmonary artery pressure before repair by direct catheterization.
Conclusion; pre-operative echocardiography may be a useful tool for assessing pulmonary artery pressure, but that it may under-estimate pulmonary artery pressure compared to intraoperative assessment by direct catheterization. Elevated pre-operative pulmonary artery pressure, as assessed by echocardiography, may be associated with certain postoperative outcomes. Echocardiography alone may be insufficient to obtain the anatomic and functional information needed for surgical repair in CHD and may require preoperative catheterization. In conclusion, cardiac catheterization is necessary to delineate pulmonary artery anatomy, origin and hemodynamic assessment for operability in CHD with severe PAH