Effects on pulmonary arterial systolic pressure after surgical closure of ventricular septal defect

Abstract

Background: Pulmonary arterial hypertension (PAH) is a common complication of ventricular septal defect (VSD) caused by chronic left-to-right shunting and increased pulmonary blood flow. This study evaluated the effect of surgical VSD closure on pulmonary arterial systolic pressure (PASP) in patients with varying degrees of pulmonary hypertension. Methods: This prospective observational study was conducted in the Department of Cardiac Surgery, Bangladesh Medical University (BMU), Dhaka, Bangladesh, from July 2022 to June 2024. Sixty patients with isolated VSD and pulmonary hypertension who underwent elective surgical closure were enrolled and divided into three groups according to preoperative PASP: Group A (36–45 mmHg), Group B (46–60 mmHg) and Group C (>60 mmHg). PASP was assessed by transthoracic Doppler echocardiography before surgery, on the first postoperative day, at one month and at three months after surgery. Data were analyzed using SPSS version 26 and a p value <0.05 was considered statistically significant. Results: The mean age ranged from 5.98±4.31 to 6.33±3.88 years, with no significant differences in age or sex distribution among the groups. PASP decreased progressively following surgical closure in all groups. Significant reductions were observed on the first postoperative day and at one month (p<0.001). By three months, mean PASP decreased to 27.80±7.96 mmHg, 28.40±4.95 mmHg and 30.05±9.83 mmHg in Groups A, B and C, respectively, with no significant difference among the groups (p=0.285). One postoperative death occurred in the severe pulmonary hypertension group. Conclusions: Surgical closure of VSD significantly reduces pulmonary arterial systolic pressure across all grades of pulmonary hypertension. Early surgical intervention may facilitate reversal of pulmonary hypertension and improve postoperative hemodynamic outcomes.