Predicting operability in children with acyanotic congenital heart diseases and severe pulmonary hypertension

ObjectiveTo investigate whether peri-operative risk stratification of children with ventricular septal defect (VSD) and complete atrioventricular septal defect (CAVSD) complicated with elevated pulmonary vascular resistance could be predicted solely based on measuring systemic oxygen saturation (SaO2) without performing cardiac catheterization.MethodsRecords of patients with VSD and CAVSD, who underwent cardiac catheterization from 2002 to 2012 were reviewed and grouped as low (A) and high (B) risk, based on the pulmonary vascular resistance (PVRI) of ⩽ or >6 Woods units (WU) in room air, respectively. Patients in group B underwent oxygen study to assess pulmonary vascular reactivity. Patients with PVRI ⩽ 6 WU in either room air or on 100% oxygen were deemed operable.ResultsSeventy-six patients; (VSD = 45, CAVSD = 31) underwent measurement of pulmonary vascular resistance. All patients with VSD were operated. Forty-two of them had systemic oxygen saturation (SaO2) ⩾ 94%. Twenty-four of 31 patients with CAVSD were operated and had SaO2 ⩾ 83%. SaO2 of ⩾83% in CAVSD and ⩾94% in VSD had sensitivity and specificity of 95% and 100%, respectively to predict pulmonary vascular resistance based operability.ConclusionOxygen saturation on pulse oximetry of ⩾94% in children with VSD and 83% with CAVSD accurately identified operable patients. This criterion may be used as an alternate to invasive assessment of pulmonary vascular resistance. Outcome of operable patients having PVRI > 6 WU in room air is good and similar to those with PVRI < 6 WU.