Review Article
Pulmonary Hypertension in Children across Africa: The Silent Threat
Table 3
Recommendations for the operability of PAH-CHD [
2,
30,
57,
73,
78].
| | Category 1 (favorable) (clinical) | Category 2 (Cath) | Category 3 (borderline) | Category 4 (unfavorable) |
| | Age | <9 months | | <2 years | >2 years | | Oxygen saturation | >95% | If category 1 is absent | | <90%
Or SPO2 drop by 19% during exercise or PaO2 by >10% which is inoperable | | Failure to thrive | Yes | | | N/A | | Signs of heart failure | Symptomatic
Recurrent chest infections, plethora and cardiomegaly on chest X-ray | | | Reduced symptoms, oligemia, and normal cardiothoracic ratio on chest radiograph | | Syndromic | Syndromic and favorable | | Down syndrome | Down syndrome with features in categories 3 and 4 | | Cyanosis | Suggests severe lung disease or intracardiac shunting | | Could be hypoxic on pulse oximetry | Present | | ECG | Left atrial/ventricular hypertrophy | | | Right atrial enlargement and RVH | | Shunt flow | Left to right shunt | | Bidirectional | Right to left | | PVRI (WU·m2) | N/A | <6 (WU·m2) | 6-8 (WU·m2) | >8 WU·m2 | | PVR/SVR | N/A | 0.3 | 0.3-0.5 | Advanced PH therapy | | Options | | | PH treatment
Repeat cardiac catheterization | Targeted PH therapy
Repeat cardiac catheterization | | Options | Operate | Operate with standard PH protocol | If , operate but patch fenestrate/leave pop off at the atrial septum | High risk for surgery, fenestrate patch
Inoperable |
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CHD: congenital heart disease; ECG: electrocardiogram; PAH: pulmonary arterial hypertension; PH: pulmonary hypertension; PVRi: pulmonary vascular resistance index; RVH: right ventricular hypertrophy; SVR: systemic vascular resistance; WU: Wood units.
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