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Clinical Investigations: CARDIOLOGY |

Lung Biopsy Diagnosis of Operative Indication in Secundum Atrial Septal Defect With Severe Pulmonary Vascular Disease*

Shigeo Yamaki, MD; Munetaka Kumate, MD; Susumu Yonesaka, MD; Katsuhide Maeda, MD; Masato Endo; Koichi Tabayashi, MD
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*From the Japanese Research Institution of Pulmonary Vasculature (Dr. Yamaki), Shiroishi; Department of Cardiovascular Surgery (Dr. Kumate), St. Maria Hospital, Kurume; Department of Pediatrics (Dr. Yonesaka), Hirosaki University School of Health Science, Hirosaki; Department of Cardiothoracic Surgery (Dr. Maeda), Tokyo University, Tokyo; and Department of Cardiovascular Surgery (Drs. Endo and Tabayashi), Tohoku University Hospital, Sendai, Japan.

Correspondence to: Shigeo Yamaki, MD, Japanese Research Institution of Pulmonary Vasculature, 40–1 Usagisaku, Shiroishi, Miyagi Pref., Japan 989-0228; e-mail: syamaki@ff.iij4u.or.jp



Chest. 2004;126(4):1042-1047. doi:10.1378/chest.126.4.1042
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Objective: Surgical indication was determined by lung biopsy in 91 patients with secundum atrial septal defect (ASD) and severe pulmonary hypertension > 70 mm Hg of pulmonary arterial peak pressure and/or pulmonary vascular resistance of > 8 U/m2.

Methods and results: Pulmonary vascular disease (PVD) in ASD was classified into four types: (1) Musculoelastosis consisting of longitudinal muscle bundles and elastic fibers; surgery is indicated no matter how severely the peripheral small pulmonary arteries are occluded. Surgery was performed in all of the 20 patients, and the postoperative course was uneventful. (2) Plexogenic pulmonary arteriopathy: surgery is indicated for a PVD index ≤ 2.3. Surgery was performed in 25 of the 32 patients. The remaining seven patients for whom surgery was not indicated are under follow-up observation. No deaths have occurred among the 32 patients. (3) Thromboembolism of small pulmonary arteries: Surgery is indicated for all such cases. Surgery was indicated in all of the five patients. (4) Mixed type of plexogenic pulmonary arteriopathy and musculoelastosis: Surgery is indicated if the collateral is not observed. Surgery was performed in 15 of the 25 patients. The remaining 10 patients for whom surgery was not indicated are under follow-up observation. Nine of these 91 patients associated with primary pulmonary hypertension were eliminated from this study.

Conclusion: No deaths due to PVD occurred among the 82 patients who underwent lung biopsy diagnosis. Lung biopsy diagnosis is concluded to be very effective.

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