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Persistence of pulmonary hypertension in patients with ventricular septal defect after intracardiac repair: insights from a long-term follow-up study

Published online by Cambridge University Press:  27 October 2025

Yuko Wakisaka Open the ORCID record for Yuko Wakisaka [Opens in a new window] ,
Kei Inai ,
Gen Harada ,
Seiji Asagai Open the ORCID record for Seiji Asagai [Opens in a new window]  and
Eriko Shimada
Yuko Wakisaka
Affiliation:
Department of Pediatric Cardiology and Adult Congenital Cardiology, Heart Institute, Tokyo Women’s Medical University, Shinjuku, Tokyo, Japan
Kei Inai*
Affiliation:
Department of Pediatric Cardiology and Adult Congenital Cardiology, Heart Institute, Tokyo Women’s Medical University, Shinjuku, Tokyo, Japan
Gen Harada
Affiliation:
Department of Pediatric Cardiology and Adult Congenital Cardiology, Heart Institute, Tokyo Women’s Medical University, Shinjuku, Tokyo, Japan
Seiji Asagai
Affiliation:
Department of Pediatric Cardiology and Adult Congenital Cardiology, Heart Institute, Tokyo Women’s Medical University, Shinjuku, Tokyo, Japan
Eriko Shimada
Affiliation:
Department of Pediatric Cardiology and Adult Congenital Cardiology, Heart Institute, Tokyo Women’s Medical University, Shinjuku, Tokyo, Japan
*
Corresponding author: Kei Inai; Email: inai.kei@twmu.ac.jp
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Abstract

Background:

Ventricular septal defect is the most common CHD and is complicated by pulmonary hypertension in about 5% of cases. Although long-term outcomes after repair are generally good, persistent pulmonary hypertension has been reported, especially before the widespread treat-and-repair strategy.

Methods:

We retrospectively analysed patients aged ≥13 years who underwent repair for ventricular septal defect with pulmonary hypertension at our centre (1970–2024). Pre- and post-operative hemodynamics were assessed. Patients were grouped by preoperative pulmonary vascular resistance (≥3 vs. <3 Wood units). Residual pulmonary hypertension was evaluated by echocardiography.

Results:

We studied 115 patients (43 male, 72 female). Follow-up reached 47 years (median 18.5). Residual pulmonary hypertension occurred in 3/115 (2.6%). Median age at intracardiac repair was 5 months. No significant differences were seen between patients with and without residual pulmonary hypertension in age at surgery, preoperative estimated right ventricular pressure, mean pulmonary artery pressure, or postoperative estimated right ventricular pressure. Mean pulmonary artery pressure was higher in the pulmonary vascular resistance ≥3 group than in the <3 group (47 ± 13 vs. 38 ± 11 mmHg, p = 0.019), while postoperative estimated right ventricular pressure did not differ. Among the 3 with residual pulmonary hypertension, 2 underwent intracardiac repair after 1 year of age.

Conclusions:

Most patients with ventricular septal defect and pulmonary hypertension had resolution after intracardiac repair; however, residual pulmonary hypertension occurred in about 2.6% during long-term follow-up. Preoperative hemodynamics did not predict persistence. Long-term periodic follow-up remains important after surgery.

Keywords

Ventricular septal defectpulmonary hypertensionintracardiac repairadult CHD

Information

Type
Original Article
Information
Cardiology in the Young , First View , pp. 1 - 5
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Copyright
© The Author(s), 2025. Published by Cambridge University Press

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