Analysis Of Risk Factors Associated With Pulmonary Hypertion In Ventricular Septal Detect Patients

Objective:Analysis the clinical characteristics of the Ventricular Septal Detect (VSD) patients with Pulmonary Arterial Hypertion (PAH). To clear the percentage of VSD associated PAH in all VSD patients and its influencing factors. Using Receiver Operating Characteristic curve (ROC curve) to evaluate the clinical diagnosis value of the patients’ weight and defect aperture, to evaluate the cutoff value of the both indicators level as predicting factors for thePAH. At the same time, study the risk factors ofPAH.Methods:Hospitalized the VSD patients who were younger than3years old in cardiac surgery of Wuhan Union Hospital from January2012to August2012were retrospectively analyzed. Doppler echocardiograpy was employed to measure the level of pulmonary artery systolic pressure (PASP). PAH occurred when there was an increase in PASP>40mmHg at rest. Record the patients’ gender, age, weight, type of defect, defect in the aperture size, ejection fraction (EF), whether merger of atrial septum defect (patent foramen ovale) and electrocardiogram (ECG) changes. Divide the VSD patients into two groups, PAH group (105cases) and no PAH group (167cases). Compare the physical data and echocardiographic parameters. Use spss13.0 statistical software to draw ROC curves of weight and defect aperture. The clinical characteristics in the two groups were analyzed with a multivariate logistic model, to discover the risk factors of VSD with PAH in patients.Results:In all VSD patients,105patients were concurrent PAH (38.6%), and about70patients rounded into Eisenmenger syndrome, about66.7%of PAH. The area under the ROC curves of weight and defect aperture were0.833and0.88, illustrated that the two indications have certain relevance with the diagnosis of VSD with PAH, and the best cutoff value were7.75kg and0.75cm.In this study the incidence of VSD with PAH increased along with the augment of defect in the aperture (OR=24.449, P<0.001); Along with the age increasing, the correlation between PAH occur and defect aperture were more close; on the ECG, lead V5ST segment on down and T wave two-way or inversion increased in patients with PAH (OR=8.114, P<0.001).Conclusion:The occurrence of PAH is influenced by many factors, in age3years old or less in children with VSD, PAH is a common complication of VSD. The lighter weight, the larger defect aperture, lead V5ST segment on down and T wave two-way or inversion on the ECG were high risk infectors of PAH. The best cutoff value of weight and defect aperture helps to assist the diagnosis of VSD with PAH and to guide further therapy.