{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T17:52:24Z","timestamp":1787507544245,"version":"build-2736575974"},"reference-count":27,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2019,8,1]],"date-time":"2019-08-01T00:00:00Z","timestamp":1564617600000},"content-version":"vor","delay-in-days":31,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2019,7,1]],"date-time":"2019-07-01T00:00:00Z","timestamp":1561939200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100001807","name":"Funda\u00e7\u00e3o de Amparo \u00e0 Pesquisa do Estado de S\u00e3o Paulo","doi-asserted-by":"publisher","award":["2011\/09341\u20100"],"award-info":[{"award-number":["2011\/09341\u20100"]}],"id":[{"id":"10.13039\/501100001807","id-type":"DOI","asserted-by":"publisher"}]},{"name":"FAPESP - Foundation for Research Support of the State of S\u00e3o Paulo, Brazil","award":["grant # 09341-0"],"award-info":[{"award-number":["grant # 09341-0"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Pulm. circ."],"published-print":{"date-parts":[[2019,7]]},"abstract":"<jats:p>\n                    Management of pediatric pulmonary hypertension associated with congenital heart disease (PHT\u2010CHD) is challenging. Some patients have persistently elevated pulmonary artery pressure (PAP) after cardiac surgery, an undesired condition that is difficult to predict. We investigated the value of clinical, hemodynamic, and histopathological data in predicting the outcome in a prospective cohort. Patients with PHT\u2010CHD received sildenafil orally pre\u2010 and postoperatively for six months and then were subjected to a catheter study. Thirty\u2010three patients were enrolled (age range\u2009=\u20094.6\u201337.0\u00a0months). Pulmonary vascular resistance (PVR) was 4.9 (range\u2009=\u20093.9\u20137.2) Wood units\u2009\u00d7\u2009m\n                    <jats:sup>2<\/jats:sup>\n                    (median with IQR). Twenty\u2010two patients had a\u2009\u2265\u200920% decrease in PVR and pulmonary\u2010to\u2010systemic vascular resistance ratio (PVR\/SVR) in response to inhaled nitric oxide (NO). The response was directly related to the degree of medial hypertrophy of pulmonary arterioles (\n                    <jats:italic>P<\/jats:italic>\n                    \u2009&lt;\u20090.05) (morphometric analysis, intraoperative lung biopsy). Subsequently, five of the non\u2010responders had a\u2009\u2265\u200930% increase in pulmonary blood flow in response to sildenafil (3.0 [2.0\u20134.0] mg\/kg\/day). Six months after surgery, PAP and PVR were significantly lower (\n                    <jats:italic>P<\/jats:italic>\n                    \u2009&lt;\u20090.001 vs. baseline), even in seven patients with Heath\u2010Edwards grade III\/IV pulmonary vascular lesions (\n                    <jats:italic>P<\/jats:italic>\n                    \u2009=\u20090.018), but still abnormal in 12\u00a0individuals (&gt;25\u2009mmHg and &gt;3.0\u2009U\u2009\u00d7\u2009m\n                    <jats:sup>2<\/jats:sup>\n                    , respectively). A preoperative PVR\/SVR of \u226524% during NO inhalation and a wall thickness of arteries accompanying respiratory bronchioli of \u22654.7 (Z score) were identified, respectively, as risk and protection factors for abnormal postoperative hemodynamics (hazard ratio [95% CI]\u2009=\u20091.09 [1.01\u20131.18],\n                    <jats:italic>P<\/jats:italic>\n                    \u2009=\u20090.036; and 0.69 [0.49\u20130.98],\n                    <jats:italic>P<\/jats:italic>\n                    \u2009=\u20090.040, respectively). Thus, in PHT\u2010CHD patients receiving oral sildenafil pre\u2010 and post\u2010surgical repair of cardiac lesions, mid\u2010term postoperative outcome is predictable to some extent.\n                  <\/jats:p>","DOI":"10.1177\/2045894019837885","type":"journal-article","created":{"date-parts":[[2019,2,26]],"date-time":"2019-02-26T05:02:30Z","timestamp":1551157350000},"page":"1-13","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":14,"title":["Parameters associated with outcome in pediatric patients with congenital heart disease and pulmonary hypertension subjected to combined vasodilator and surgical treatments"],"prefix":"10.1002","volume":"9","author":[{"given":"Ana Maria","family":"Thomaz","sequence":"first","affiliation":[{"name":"Heart Institute University of S\u00e3o Paulo School of Medicine S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luiz J.","family":"Kajita","sequence":"additional","affiliation":[{"name":"Heart Institute University of S\u00e3o Paulo School of Medicine S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vera D.","family":"Aiello","sequence":"additional","affiliation":[{"name":"Heart Institute University of S\u00e3o Paulo School of Medicine S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Le\u00edna","family":"Zorzanelli","sequence":"additional","affiliation":[{"name":"Heart Institute University of S\u00e3o Paulo School of Medicine S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Filomena Regina B.G.","family":"Galas","sequence":"additional","affiliation":[{"name":"Heart Institute University of S\u00e3o Paulo School of Medicine S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cleide G.","family":"Machado","sequence":"additional","affiliation":[{"name":"Hospital das Cl\u00ednicas University of S\u00e3o Paulo School of Medicine S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miguel","family":"Barbero\u2010Marcial","sequence":"additional","affiliation":[{"name":"Heart Institute University of S\u00e3o Paulo School of Medicine S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcelo B.","family":"Jatene","sequence":"additional","affiliation":[{"name":"Heart Institute University of S\u00e3o Paulo School of Medicine S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marlene","family":"Rabinovitch","sequence":"additional","affiliation":[{"name":"Stanford University School of Medicine Stanford CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4448-4911","authenticated-orcid":false,"given":"Antonio Augusto","family":"Lopes","sequence":"additional","affiliation":[{"name":"Heart Institute University of S\u00e3o Paulo School of Medicine S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,8]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2015-308378"},{"issue":"1","key":"e_1_2_10_3_1","first-page":"I76","article-title":"Inhaled Nitric Oxide as a Preoperative Test (INOP Test I): the INOP Test Study Group","volume":"106","author":"Balzer DT","year":"2002","journal-title":"Circulation"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1067\/mtc.2002.121497"},{"issue":"2","key":"e_1_2_10_5_1","first-page":"161","article-title":"Long\u2010term outcome of patients operated for large ventricular septal defects with increased pulmonary vascular resistance","volume":"55","author":"Kannan BR","year":"2003","journal-title":"Indian Heart 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