Development of pulmonary hypertension remains a major hurdle to corrective surgery in Down syndrome  

作　　者：Akash Batta Juniali Hatwal 

机构地区：[1]Department of Cardiology,Dayanand Medical College and Hospital,Ludhiana 141001,Punjab,India [2]Department of Internal Medicine,Post Graduate Institute of Medical Education&Research,Chandigarh 160012,India

出　　处：《World Journal of Cardiology》2024年第1期1-4,共4页世界心脏病学杂志（英文版）（电子版）

摘　　要：Down syndrome is the most common chromosomal abnormality encountered in clinical practice with 50%of them having associated congenital heart disease(CHD).Shunt lesions account for around 75%of all CHDs in Down syndrome.Down syndrome patients,especially with large shunts are particularly predisposed to early development of severe pulmonary hypertension(PH)compared with shunt lesions in general population.This necessitates timely surgical correction which remains the only viable option to prevent long term morbidity and mortality.However,despite clear recommendations,there is wide gap between actual practice and fear of underlying PH which often leads to surgical refusals in Down syndrome even when the shunt is reversible.Another peculiarity is that Down syndrome patients can develop PH even after successful correction of shunt.It is not uncommon to come across Down syndrome patients with uncorrected shunts in adulthood with irreversible PH at which stage intracardiac repair is contraindicated and the only option available is a combined heartlung transplant.However,despite the guidelines laid by authorities,the rates of cardiac transplant in adult Down syndrome remain dismal largely attributable to the high prevalence of intellectual disability in them.The index case presents a real-world scenario highlighting the impact of severe PH on treatment strategies and discrimination driven by the fear of worse outcomes in these patients.

关 键 词：Down syndrome Congenital heart disease Pulmonary hypertension Cardiac transplantation Pulmonary vascular resistance Surgical correction 

分 类 号：R726.1[医药卫生—儿科]