Pulmonary Hypertension Expert Forum
Reversibility of pulmonary hypertension
About This Forum:

Pulmonary hypertension is a condition associated with high blood pressure in the arteries that connect your heart with your lungs. It is a serious condition for which there are many emerging treatments but no definite cure. In this disease, the blood vessels that carry oxygen-poor blood from your heart to your lungs become hard and narrow, which causes your heart to work harder to pump the blood. This forum is a place to ask questions about Pulmonary Hypertension. Some examples are: What caused me to get pulmonary hypertension? How is pulmonary hypertension diagnosed? What treatment options are available?

IMPORTANT!! If you have a question that requires immediate medical attention, or if you think you may have an emergency situation, please call your doctor or 911 IMMEDIATELY!

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Reversibility of pulmonary hypertension

I have this question:
When is it reversible pulmonary hypertension due to a VSD ? What are the requirements ?
Thank you in advance for your help!
1884349_tn?1353818598
Hello and welcome to the forum.

Intracardiac shunts (ASD, VSD, and PDA) can all lead to pulmonary hypertension over time if not corrected.  When one thinks about "reversibility" in these settings, one is most concerned with whether the shunt is left to right  (they all begin as left to right shunts) or whether they are now right to left (or an in between category referred to as "bidirectional").

When the shunts begin to push blood from right to left (as opposed to left to right), this means that the pulmonary hypertension has become quite severe.  And while there are treatments for this condition (referred to as "Eisenmengers"), what is no longer an option is repairing or closing the defect/hole (because the right ventricle in many respects now actually depends on the defect to get blood to the left side of the heart because of the severe pulmonary hypertension).  If one were to close the "hole" in someone with Eisenmengers, they could develop refractory right ventricular failure and death.

An expert in pulmonary hypertension should know how to evaluate somebody with a VSD (or other defect) and determine the correct treatment strategy.

Hope this helps.

Best,

Dr. Rich
6 Comments
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4738587_tn?1360352750
Dear Dr. Rich,

Thank you very much for your answer.

I thought that there is a limit for the RVSP under which the shunt's repair is admissible, isn't  there? And if the pulmonary hypertension has become somewhat severe, is there any medication to improve it so that to be suitable for closure?

Could you tell me a little bit more about what the symptoms are in each stage of the disease?

Thank you in advance.



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1884349_tn?1353818598
This is a very complex topic.

1. There is no "limit" for the RVSP to determine whether or not a shunt is repairable or not.
2. When a shunt is thought to be "bidirectional", there are instances when drug testing can be performed (coupled with other types of tests) to determine how "reversible" the PH is and whether repair may be feasible.
3. If you or a loved one is confronted with such a case, you MUST seek out expert care at a center of excellence.

All the best,

Dr. Rich
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4738587_tn?1360352750
Thank you very much.
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4738587_tn?1360352750
Hello, Dr. Rich.

I would also like to ask you if it is possible that pulmonary hypertension could affect a woman's menstruation? Even indirectly.

Thank you.

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4738587_tn?1360352750
If you would like to have more information or there's any problem, let me know.

Thank you.
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This Forum's Experts
1884349_tn?1353818598
Jonathan D. Rich, MDBlank
Northwestern Memorial Hospital
Chicago, IL
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