The natural history of pulmonary hypertension and pulmonary vascular change in patients with certain forms of congenital heart disease is a subject of utmost importance in light of advanced surgical techniques which now allow for surgery for almost any type of cardiac lesion. The optimal age for surgical intervention for many of the cardiac lesions is not known, but one of the more important factors to be considered is the vascular change resulting from abnormal amounts of pulmonary blood flow and pressure. Severe histologic changes may be irreversible or may greatly increase the risks of surgery. The following is a review of the pertinent literature and present thinking of workers in this field.
Welch1 in 1947 studied the pulmonary changes in 67 patients with congenital heart disease consisting of patent ductus arteriosus (PDA), interatrial septal defect (IASD), and interventricular septal defect (IVSD). A control series of 10 noncardiac patients