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MCQ 17: Operability in acyanotic congenital heart diseases (23)

Q. All of the following predict non-operability in acyanotic congenital heart diseases with increased pulmonary artery pressure except?
A. Baseline saturation less than 92%
B. PVRI/SVRI >0.3
C. PVRI > 6 woods units/m2
D. Qp/Qs > 2.0

Answer: D. Qp/Qs > 2.0

Explanation:
In acyanotic congenital heart diseases (ASD, VSD, PDA, Complete AVSD) with pulmonary artery hypertension, there is a great dilemma for complete repair of the defect. Because if the patient has developed Eisenmenger syndrome, then he will have a poorer prognosis after surgery.
Baseline saturation of less than 92% suggests significant reversal of shunt due to increased PA pressure. During cardiac catheterization study, pulmonary vascular resistance index (PVRI) more than 6 W/m2 and PVRI/SVRI more than 0.3 suggest significantly raised pulmonary artery pressure. These patients might not do well after surgical closure of the defect. For further decision regarding surgery in these cases, vasodilator testing is indicated.
Pulmonary blood flow/Systemic blood flow (Qp/Qs) is a measurement of the volume of left to right shunting of blood. If it is significant (>2.0), this may lead to the development of Eisenmenger syndrome, hence is an indication for surgical closure of the defect. 
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