Abstract
Introduction. There are still a lot of patients with ventricular septal defect (VSD) over 1 and more years old which need of surgical treatment. Severe pulmonary vascular changes may be a contraindication for open heart surgery. The purpose of this study is to determine the role of lung biopsy in indication for palliative repair or complete surgery.
Materials and methods. During the period from 1981 to 2013 251 lung biopsy specimens were obtained from patients with VSD for evaluation. Age of them was from 2 months to 39 years. Autopsy material of 3 patients with ventricular septal defect and pulmonary hypertension embryonic form 5, 6 and 9 months died after VSD correction because of the residual high pulmonary hypertension was also included in study. Serial sections (10—15) were stained with routine methods. While using the morphometric analysis medial wall thickness index (MWT) of small arteries was estimated with countering the number of arteries per 100 alveoli.
Results. In children under 1 year of the age pulmonary vascular changes were: hypertrophy of the vascular medial wall, intimal cell proliferation and sclerosis of small arteries (I—III grade of Heath—Edwards classification). In children from 1 to 3 years were revealed a wide variety of morphological changes from I to V grade of Heath—Edwards classification, plexiform lesions, thinning of the medial wall and hemosiderosis. Heath—Edwards grade (H—E gr.) IV of vascular changes were in 37% of patients and grade V only in 1. In children from 3 to 5 years and older the percentage of severe changes was higher (grade IV — 47.6%, and grade V — 10%). Morphometric analysis revealed variation in the MWT value of respiratory bronchioles arteries in the early H—E grs. (I—III) from 38.6+4.8 to 40.3+8.1% and decreasing of MWT from 22.9±4.7 to 19.3+3.1% in IV -V H -E gr.
Conclusion. On the basis of morphological analysis of 251 lung biopsy specimens, we concluded that in infants under 1 year old with ventricular septal defect pulmonary vascular changes proved to be no more than I-III of Heath-Edwards grade being within reversibility after surgery. In these cases the pulmonary biopsy is not required, except in patients aged from 1 to 3 months with suspected substantial medial wall hypertrophy of small arteries. Morphometric analysisis very important and indicated to patients less than 3 years with the criteria of V.I. Bourakovsky clinical classification group III.
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