Vernant P
Schweiz Med Wochenschr. 1977 Nov 5;107(44):1547-51.
Late closure of left to right shunts with pulmonary hypertension may leave residual pulmonary hypertension. To determine the best period for total repair, a large number of factors must be taken into account: --the spontaneous evolution of left to right shunts; --the prognosis or residual pulmonary hypertension after total repair; --the probability of total recovery after surgery of the various types of shunting, related to the age of operation. From these factors, it appears that: --the closure of atrial septal defects (where pulmonary hypertension is never major in the child) can wait till childhood or adolescence; --ductus arteriosus must be repaired before the age of 2 years; --in ventricular septal defects with pulmonary hypertension, the best chance of recovery is secured when surgery is performed between the ages of 1 and 2. Earlier intervention should be considered only if medical therapy is ineffective. After that period, it may leave pulmonary hypertension in being.
左向右分流伴肺动脉高压的晚期闭合可能会残留肺动脉高压。为了确定完全修复的最佳时机，必须考虑大量因素：——左向右分流的自然演变；——完全修复后的预后或残留肺动脉高压；——与手术年龄相关的各类分流手术后完全恢复的可能性。从这些因素来看：——房间隔缺损（儿童期肺动脉高压通常不严重）的闭合可推迟至儿童期或青春期；——动脉导管未闭必须在2岁之前修复；——伴有肺动脉高压的室间隔缺损，在1至2岁之间进行手术时恢复的最佳机会最大。只有当药物治疗无效时才应考虑更早干预。在此之后，可能会遗留肺动脉高压。
