Progressive pulmonary vascular disease after pulmonary artery banding and total correction in a case of ventricular septal defect and pulmonary hypertension

A 7-month-old infant with ventricular septal defect and pulmonary hypertension underwent pulmonary artery banding, which resulted in a decrease in the pulmonary arterial peak pressure from 102 to 54 mmHg. Lung biopsy findings showed at most an early grade 3 Heath-Edwards classification, and an index...

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Bibliographic Details
Published in:General thoracic and cardiovascular surgery 1999-05, Vol.47 (5), p.229-233
Main Authors: Yamaki, S, Yonesaka, S, Suzuki, S, Nagumo, K, Ouchi, K, Takahashi, T
Format: Article
Language:English
Subjects:
Biopsy
Disease Progression
Female
Heart Septal Defects, Ventricular - complications
Heart Septal Defects, Ventricular - surgery
Humans
Hypertension, Pulmonary - etiology
Hypertension, Pulmonary - pathology
Hypertension, Pulmonary - surgery
Hypertrophy
Infant
Necrosis
Postoperative Complications
Pulmonary arteries
Pulmonary Artery - pathology
Pulmonary Artery - surgery
Pulmonary hypertension
Vascular Surgical Procedures
Veins & arteries
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Summary:A 7-month-old infant with ventricular septal defect and pulmonary hypertension underwent pulmonary artery banding, which resulted in a decrease in the pulmonary arterial peak pressure from 102 to 54 mmHg. Lung biopsy findings showed at most an early grade 3 Heath-Edwards classification, and an index of pulmonary vascular disease of 1.4, both of which indicated operability for total correction. Small pulmonary arteries less than 100 microns in diameter, however, showed marked hydropic changes in the medial smooth muscle cells. Total correction was performed at the age of 2 years, but the pulmonary arterial pressure failed to decrease. A lung biopsy taken just after the closure of the ventricular septal defect contraindicated operability due to progressive pulmonary vascular disease at a grade 6 Heath-Edwards classification and an index of pulmonary vascular disease of 2.4. The patient died at 8 months after the operation, and an autopsy revealed still more advanced pulmonary vascular disease at a grade 6 Heath-Edwards classification and an index of pulmonary vascular disease of 2.8. The pathogenesis of arterial changes is discussed.
ISSN:1344-4964
1863-6705
1863-2092
1863-6713
DOI:10.1007/bf03218001