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.
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?
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.
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