Relationship of Pulmonary Artery Pressure and Shunt Burden With Lesion Type, Sex, and Age in Children with Congenital Heart Disease: A Two-center Retrospective Study

Saadet Aydın; Özlem Bayram

doi:10.4274/kvbulten.galenos.2026.65365

Abstract

Objective

This study aimed to evaluate the distribution of pulmonary artery pressure and Qp/Qs ratio according to lesion type, sex, and age in children with congenital heart disease.

Material and Methods

Data from children with congenital heart disease followed at two centers were retrospectively reviewed. A total of 179 patients were included. Demographic characteristics, diagnostic distribution, echocardiographic hemodynamic parameters, and laboratory findings were recorded. Hemodynamic differences according to sex and diagnosis were analyzed, and correlations between variables were assessed using Spearman correlation analysis.

Results

The mean age was 68.1±54.6 months; 107 patients (59.8%) were girls and 72 (40.2%) were boys. The most frequent diagnoses were secundum atrial septal defect (ASD) (35.8%), muscular ventricular septal defect (VSD) (15.1%), patent ductus arteriosus (PDA) (14.5%), and previously closed/repaired VSD (29.6%). Mean pulmonary artery pressure was 24.2±12.1 mmHg in boys and 21.6±11.7 mmHg in girls (p=0.214). Systolic pulmonary artery pressure was higher in boys than in girls (36.5±19.8 vs. 30.4±16.9 mmHg, p=0.04), whereas diastolic pulmonary artery pressure (16.5±10.4 vs. 13.7±8.1 mmHg, p=0.125) and Qp/Qs ratio (1.9±0.8 vs. 2.1±1.3, p=0.520) did not differ significantly. According to diagnosis, mean pulmonary artery pressure was 18.2±4.3 mmHg in ASD, 28.1±13.7 mmHg in VSD, 22.1±10.4 mmHg in PDA, and 25.8±15.7 mmHg in previously closed/repaired VSD patients. Corresponding Qp/Qs ratios were 2.1±1.1, 2.2±1.1, 1.8±1.2, and 1.9±0.9, respectively. While Qp/Qs did not differ significantly across diagnostic groups (p=0.113), mean pulmonary artery pressure did (p=0.007), being highest in VSD and previously closed/repaired VSD and lowest in ASD. Spearman analysis showed positive correlations of age with height (r=0.616, p<0.001), body weight (r=0.914, p<0.001), hemoglobin (r=0.454, p<0.001), Qp (r=0.383, p<0.001), and Qs (r=0.701, p<0.001), and negative correlations with lymphocyte count (r=-0.720, p<0.001) and systolic pulmonary artery pressure (r=-0.325, p<0.001). Lymphocyte count was also negatively correlated with Qs (r=-0.542, p<0.001).

Conclusion

Pulmonary artery pressure differs according to lesion type in children with congenital heart disease. The finding of higher mean pulmonary artery pressure in VSD and previously closed/repaired VSD despite similar Qp/Qs ratios suggests that pulmonary vascular involvement cannot be explained solely by shunt magnitude. Lesion-specific hemodynamic burden may play a central role in pulmonary vascular response during childhood.

Keywords:

Congenital heart disease, pulmonary hypertension, child, ventricular septal defect, atrial septal defect, patent ductus arteriosus

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