Limitations of cardiac catheterization as a predictor of reversibility in severe pulmonary hypertension associated to ventricular septal defects

Abstract

Introduction: Cardiac catheterization is a mandatory investigation in the study of patients affected of congenital heart diseases complicated with severe pulmonary hypertension. However, in some occasions we have retrospectively observed, as others authors describe, that the results of this study did not contribute in a proper way to a correct decision making referring to the performance of corrective surgery. Objective: The purpose of this paper consisted in trying to get a better precision about the limitations of cardiac catheterization in patients with congenital heart diseases and severe pulmonary hypertension by comparing its results with those of the anatomopathology test and surgical outcome. Materials and methods: We reviewed the clinical records of 23 patients affected with a ventricular septal defect and severe pulmonary hypertension submitted to corrective surgery with a follow up period in alive patients of no less than two years. Results: We observed lack of coincidence between the results of cardiac catheterization study and those of the pulmonary biopsy and the satisfactory postoperative evolution of pulmonary hypertension in 17, 3 % of the patients. In two other patients the good results of the vasodilator test were not coincident with the result of pulmonary biopsy and outcome. It should be said that in two patients the results of anatomopathology were not coincident with postoperative outcome, but in one of them which was characterized as persistently severe pulmonary hypertension with a fatal outcome, the tissue sample of pulmonary biopsy did not include preacinar arteries. Conclusions: Cardiac catheterization test does not have an absolute value in the decision making of corrective surgery of patients with ventricular septal defect and severe pulmonary hypertension, being necessary the performance of a pulmonary biopsy in patients that show discrepancies between the results of that test with the clinical picture and the age of patients at surgery at the time to decide indication of operability.