Letter to the Editor
Pulmonary Arterial Hypertension in Congenital Heart Defects With Left-To-Right Shunt
Hipertensión arterial pulmonar en cardiopatías congénitas con cortocircuito izquierda-derecha
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Axial FLAIR image (B) showing a hyperintense focal lesion in the periventricular white matter (white arrow). Both lesions are radiologically non-specific, but in the right clinical context can be indicative of demyelinating disease.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Carmen Picón Serrano, Sara Escoda Menéndez, Luis Gorospe Sarasúa" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Carmen" "apellidos" => "Picón Serrano" ] 1 => array:2 [ "nombre" => "Sara" "apellidos" => "Escoda Menéndez" ] 2 => array:2 [ "nombre" => "Luis" "apellidos" => "Gorospe Sarasúa" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0300289614003354" "doi" => "10.1016/j.arbres.2014.08.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289614003354?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212915000993?idApp=UINPBA00003Z" "url" => "/15792129/0000005100000006/v1_201505280222/S1579212915000993/v1_201505280222/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Pulmonary Arterial Hypertension in Congenital Heart Defects With Left-To-Right Shunt" "tieneTextoCompleto" => true "saludo" => "To the Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "308" "paginaFinal" => "309" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Efrén Martínez-Quintana, Fayna Rodríguez-González" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Efrén" "apellidos" => "Martínez-Quintana" "email" => array:1 [ 0 => "efrencardio@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Fayna" "apellidos" => "Rodríguez-González" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Cardiología, Complejo Hospitalario Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Oftalmología, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hipertensión arterial pulmonar en cardiopatías congénitas con cortocircuito izquierda-derecha" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We read with interest the article published by Hernández Vázquez et al.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> on partial anomalous pulmonary venous connection with pulmonary hypertension, and we would like to put forward some thoughts that may be of interest.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Firstly, significant pulmonary arterial hypertension (PAH)<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> rarely develops in association with heart defects with left-to-right shunt and volume overload, such as partial anomalous pulmonary venous connection or drainage (PAPVD) and interatrial communication (IAC), in contrast to what the authors appear to claim in their discussion. PAPVD patients usually have normal pulmonary blood pressure, unless they have 2 pulmonary veins with abnormal return, or else sinus venous ICA with a pulmonary to systemic blood flow ratio of 1.5:1 (Qp:Qs>1.5:1). Even in this situation, severe PAH is very rarely observed (less than 5%), and is more related to genetic predisposition (as in primary PAH) than to the extent of the shunt itself.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> In contrast, when the left-to-right shunt is associated with volume and pressure overload (interventricular communication, patent ductus arteriosus, aortopulmonary window or common arterial trunk), PAH frequently becomes severe if the defect is large and left uncorrected during the first year of life. Thus, shunts resulting in volume overload are more typically found in asymptomatic or practically asymptomatic patients with right cavity dilation and mild or moderately increased pulmonary pressure, while systemic or suprasystemic pulmonary pressures with shunt reversal are found in shunts with both volume and pressure overload (Eisenmenger's syndrome).</p><p id="par0015" class="elsevierStylePara elsevierViewall">Secondly, in PAPVD patients with significant PAH, other etiologies must be ruled out. These include respiratory disease, obstructive sleep apnea, connective tissue disease, chronic thromboembolism, portal hypertension, human immunodeficiency virus, use of appetite suppressants or toxic substances, and left heart disease. In the latter, patients with multiple cardiovascular risk factors, as discussed in the article, or coronary heart disease (not specified by the authors) may develop left ventricular diastolic dysfunction and secondary pulmonary arterial hypertension, even in the absence of evidence of heart failure.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> Special precautions must be taken in these cases, since PAPVD can add to left atrial decompression and total correction of the defect may lead to a sudden increase in pulmonary venous pressure and the development of pulmonary edema.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Finally, before PAPVD or IAC correction is attempted, pulmonary vascular and systemic resistances and pressures must be identified, in order to prevent converting an Eisenmenger's syndrome into a disease with a similar course as that of primary PAH, with its correspondingly poorer prognosis.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3,5</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0025" class="elsevierStylePara elsevierViewall">None of the authors received funding.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authorship</span><p id="par0030" class="elsevierStylePara elsevierViewall">All authors participated in the interpretation of the data, writing of the article and final approval of the version for publication.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflict of Interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that they had no conflict of interests.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Authorship" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflict of Interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Martínez-Quintana E, Rodríguez-González F. Hipertensión arterial pulmonar en cardiopatías congénitas con cortocircuito izquierda-derecha. Arch Bronconeumol. 2015;51:308–309.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Partial anomalous pulmonary venous connection with pulmonary hypertension" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Hernández Vázquez" 1 => "J. de Miguel Díez" 2 => "C. de Cortina Camarero" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2014" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Atrial septal defect with severe pulmonary hypertension in elderly patients: usefulness of transient balloon occlusion" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Sánchez-Recalde" 1 => "J.M. Oliver" 2 => "G. Galeote" 3 => "A. González" 4 => "L. Calvo" 5 => "S. Jiménez-Valero" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Esp Cardiol" "fecha" => "2010" "volumen" => "63" "paginaInicial" => "860" "paginaFinal" => "864" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20609321" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "ESC Guidelines for the management of grown-up congenital heart disease (new version 2010)" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Task Force on the Management of Grown-up Congenital Heart Disease of the European Society of Cardiology (ESC); Association for European Paediatric Cardiology (AEPC); ESC Committee for Practice Guidelines (CPG)" "etal" => true "autores" => array:6 [ 0 => "H. Baumgartner" 1 => "P. Bonhoeffer" 2 => "N.M. de Groot" 3 => "F. de Haan" 4 => "J.E. Deanfield" 5 => "N. Galie" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/ehq249" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J" "fecha" => "2010" "volumen" => "31" "paginaInicial" => "2915" "paginaFinal" => "2957" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20801927" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnosis, assessment, and treatment of non-pulmonary arterial hypertension pulmonary hypertension" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.M. Hoeper" 1 => "J.A. Barberà" 2 => "R.N. Channick" 3 => "P.M. Hassoun" 4 => "I.M. Lang" 5 => "A. Manes" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2009.04.008" "Revista" => array:7 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2009" "volumen" => "54" "numero" => "Suppl 1" "paginaInicial" => "S85" "paginaFinal" => "S96" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19555862" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pulmonary hypertension related to congenital heart disease: a call for action" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "K. Dimopoulos" 1 => "S.J. Wort" 2 => "M.A. Gatzoulis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/eht437" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J" "fecha" => "2014" "volumen" => "35" "paginaInicial" => "691" "paginaFinal" => "700" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24168793" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005100000006/v1_201505280222/S1579212915001007/v1_201505280222/en/main.assets" "Apartado" => array:4 [ "identificador" => "14576" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Letters to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005100000006/v1_201505280222/S1579212915001007/v1_201505280222/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212915001007?idApp=UINPBA00003Z" ]
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