PAH is the major determinant of surgical outcome of left to right shunts. In this modern era of cardiac care allowing a child with left to right shunt to progress to a stage of Eisenmenger syndrome is considered as a huge medical failure . But , this is still rampant in many of the developing countries .
Cardiologists are divided over the issue of operability of Eisenmenger syndrome .The confusion is largely due to the conflicting data of outcome in these patients. While there is strong data when PVR exceeds SVR , the death is imminent in the post operative period .
What has complicated the issue is there are many case reports where severe PAH patients have been successfully operated. Most would think it is a statistical exception and one can not alter the traditional criteria based on few case reports.
But ,it remains an irony as on 2009 , we do not have a proper methodology to assess reversibility of PAH in Eisenmenger syndrome . Further , there is a significant number of patients with high PVR , who continue to experience an unabated left to right shunting . We do not have an answer for either the mechanism of such shunts and how to manage these patients.
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This short paper was presented in the Annual scientific sessions of cardiological society of India 2009 regarding the usefulness of a new parameter to assess reversibility of PAH. This may not be called as a study rather a report of our experience in five patients with eisenmenger syndrome
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Dr.S.Venkatesan MD 