[Surgical management of pulmonary hypertension in congenital heart diseases with left-to-right shunt].

From 1971 to 1982 lung biopsies were taken from 78 patients suffering from congenital heart diseases at corrective operations (left to right shunt, pulmonary hypertension) and in 55 patients at previous operations (41 X banding of the pulmonary artery, 9 X ligation of patent ductus arteriosus Botallo, 5 X closure of a VSD). Comparing morphological findings according to Heath and Edwards and morphometrical studies to haemodynamic findings as pulmonary to systemic pressure ratio or resistance ratio a good correlation could be shown. In 55 patients where two lung biopsies had been taken and two cardiac catheterizations were performed the pulmonary to systemic pressure ratio decreased from 0.87 prior to the first (palliative) operation to 0.41 at the time of corrective operation after an average time interval of 27 months. Morphological findings changed also as became evident at the corrective procedure. These findings support our indication for a banding of the pulmonary artery during the first 3 months of life plus conservative treatment or early correction up to the end of the first year of life in case of left to right shunt and severe pulmonary hypertension.