Effect on Natural Course of Pulmonary Vascular Diseases in Isolated Atrial Septal Defect at High Altitude

Background: Development of pulmonary vascular disease (PVD) has been considered a risk factor in the long-term course of ASD (atrial septal defect). Lung biopsy remains the gold standard to confirm the degree of severity in pulmonary vascular disease in patients with isolated ASD. Objective: To determine the effect on natural course on pulmonary vascular diseases in isolated ASD patients at high altitude .To assess the histological degree of pulmonary vascular diseases in isolated ASD patients. Material and Methods: This study was carried in the Department of Cardiovascular and Thoracic Surgery Sher-i-Kashmir Institute of Medical Sciences between 1st September 2010 to 31st November 2012.Patients with isolated ASD was included in the study. Isolated ASD Patients. Ostium secundum (OS) type. Patients residing at more than 3,500ft above sea-level. All patients were subjected to cardiac cath prior to surgery. Pulmonary vascular resistance was calculated in all patients. Lung Biopsy (which was taken during repair of ASD before patient was put on cardio pulmonary bypass) was sent for histopathological examination. Histopathological examination of the specimen was done by a single histopathologist. Severity of the pulmonary vascular disease was assigned a Score between 1 - 4. Results: histopathological score of one was seen in none whereas 5.6% of the patients (n=2) had a histopathological score of 2; 44.4 % (n=8) had a histological score of 3 and 50% (n=9) had a histological score of 4. Most of our patients (94.4%; n=17) had a higher histopathological score of 3 & 4. Conclusion: No formal study has been conducted so far to analyze the effect of high altitude on pulmonary vascular disease in Atrial Septal defect. All of our patients had established pulmonary vascular changes at the time of presentation. Severity of the pulmonary vascular disease as proved by histopathological scoring and Cath data was quite high. This is in contrast with those residing at low altitude as reported in the literature. Therefore, it seems that high altitude has a strong bearing on the natural course of the disease, its complications and outcome after surgery.

Author(s): Farooq Ahmad Ganie, GH Nabi Lone, Khursheed A khan, Rumana H Makhdoomi, Hafeezulla Lone, Mohd Lateef Wani, Imran hafeez, Mohd Arif Kelam and Masaratul-gani

Abstract | PDF

Share This Article