PULMONARY-HYPERTENSION AFTER OPERATIONS FOR CONGENITAL HEART-DISEASE - ANALYSIS OF RISK-FACTORS AND MANAGEMENT

Background: Management of pulmonary hypertension, a potentially fatal complication of operations to correct congenital heart disease, has ev olved through the last 15 years, Monitoring of pulmonary arterial pres sure and mixed venous saturation became available, and prophylactic us e of alpha-blockers and other vasodilators increased, This study exami nes risk factors for morbidity and mortality from pulmonary hypertensi on after operations to correct congenital heart disease and evaluates the impact of management changes on outcomes, Methods: By means of mul tivariable logistic regression analysis, 880 high-risk patients with c ongenital heart disease (of 2484 patients undergoing cardiopulmonary b ypass between January 1980 and December 1994) were analyzed to determi ne which were at risk for postoperative pulmonary hypertension and its associated morbidity and mortality, Results: Patients with atrioventr icular canal (n = 182), truncus arteriosus (n = 47), total anomalous p ulmonary venous connection (n = 90), transposition of great arteries ( n = 97), hypoplastic left heart syndrome (n = 50), and ventricular sep tal defect (n = 414) demonstrated a higher risk of postoperative pulmo nary hypertension, By multivariable logistic regression, preoperative pulmonary hypertension (p < 0.0001), absence of mixed venous saturatio n monitoring (p < 0.0001), and absence of prophylactic alpha-blockade (p = 0.0004) significantly increased postoperative pulmonary hypertens ion, Preoperative pulmonary hypertension (p < 0.001) and absence of pr ophylactic alpha-blockers (p = 0.0004) were significant risk factors f or in-hospital death related to pulmonary hypertension, Repair at olde r age (except in the case of total anomalous pulmonary venous connecti on) was a significant risk for postoperative pulmonary hypertension (p = 0.03), Conclusion: Mixed venous saturation monitoring and alpha-rec eptor blockade reduced the incidence of pulmonary hypertension after o perations for congenital heart disease, Early definitive repair reduce d morbidity and mortality from postoperative pulmonary hypertension.