Is lung biopsy useful for surgical decision making in congenital heart disease?

C. Frescura, G. Thiene, M. Giulia Gagliardi, A. Mazzucco, P. A. Pellegrino, L. Daliento, S. Biscaglia, M. Carminati, V. Gallucci

Research output: Contribution to journalArticlepeer-review

Abstract

Sixty patients with congenital heart disease (CHD), age range 3 months-45 years (median 2 years), underwent lung biopsy to exclude pulmonary vascular disease (PVD): 25 had an atrioventricular (AV) septal defect, 14 a ventricular septal defect (VSD), 7 a complete transposition of the great arteries (TGA) + VSD, 3 an atrial septal defect, and 2 a patent ductus arteriosus; 9 had other malformations. Scoring of histological section (0-4) according to a modified Heath-Edwards classification disclosed that 30 patients had severe “irreversible” PVD (≥ grade 3) (11 AV septal defect, 8 VSD, 6 TGA + VSD and 5 others); 8 patients were younger than 1 year. Pulmonary vascular resistance (PVR) was calculated in 51 patients and exceeded 7 U/m2 in 1 of 2 patients with grade 0, in 9 of 18 with grade 1, in 1 of 4 with grade 2, in 11 of 18 with grade 3, and in 8 of 9 with grade 4. PVR was also calculated after 100% oxygen administration in 19 patients, 14 of whom had a resting PVR ≥ 7 U/m2. PVR persisted ≥ 7 U/m2 in 5 patients: 4 had PVD ≥ grade 3 and died after surgery. PVR fell to under 7 U/m2 in 14 patients, 3 of whom had PVD ≥ grade 3:1 patient with grade 4 was not operated upon and 2 with grade 3 were operated upon: all are alive. Follow-up in discharged living patients was 100%, with a mean of 50 months. Fifty-five patients underwent surgery with 10 early and 2 late deaths. Among the 12 subjects with a fatal outcome, 10 had irreversible lesions. The 5 non-operated patients all had irreversible lesions at biopsy, and are still alive. Among the 19 patients in grade 3, 16 were operated upon and 3 were not, with 5 (31%) and 0 deaths, respectively, while among the 11 patients in grade 4, 9 were operated upon and 2 were not, with 5 (55%) and 0 deaths, respectively. In conclusion, correlation of lung biopsy findings with haemodynamic data is crucial for surgical decision making in CHD. Grade 4 in itself, and grade 3 with a persistent high PVR (≥ 7 U/m2), even after oxygen administration, constitute a very high surgical risk; such patients should be left unrepaired until progressive deterioration warrants cardiopulmonary transplantation. [Eur J Cardio-thorac Surg (1991) 5:118-123)

Original languageEnglish
Pages (from-to)118-123
Number of pages6
JournalEuropean Journal of Cardio-thoracic Surgery
Volume5
Issue number3
DOIs
Publication statusPublished - 1991

Keywords

  • Cardiac surgery
  • Congenital heart disease
  • Lung biopsy
  • Pediatric cardiology
  • Pulmonary vascular disease

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

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