{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T07:55:22Z","timestamp":1791618922613,"version":"4.3.4"},"reference-count":17,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Pulmonary artery hypertension associated with left-to-right intracardiac shunts adversely affects outcomes. Studies are limited to guide the decision to operate or not in patients presenting late with a left-to-right shunt and PAH. This study aimed to assess clinical and investigative parameters, including acute vasodilator testing (AVT) using oxygen, to predict operability decisions and outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>We conducted a retrospective analysis of patients who underwent cardiac catheterization for operability assessment over 5 years, excluding those with left-heart obstructive disease or residual postoperative lesions. A total of 157 patients (mean age: 12.8 \u00b1 12.6 years; 83 males) were included, with the majority having post-tricuspid shunt lesions (132\/157, 84%). Multiple logistic regression identified predictors of inoperability on AVT, including age &gt;2 years, absence of cardiomegaly, bidirectional or predominantly right-to-left shunting across the defect, and absence of left ventricular volume overload on echocardiography. These variables formed a scoring system with 80% specificity and 60% sensitivity for predicting inoperability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Of the 157 patients, 60 underwent surgical correction, with six experiencing right heart failure or death post-operatively, and three facing adverse outcomes during further follow-up. Univariate analysis indicated that age &gt;2 years, hemoglobin levels, single or narrowly split second heart sound, cyanosis, and a postoxygen Qp: Qs ratio &lt;0.9 were significantly associated with unfavorable outcomes among patients who underwent surgery. In the multivariate analysis, none of the parameters predicted an unfavorable surgical outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>This study highlights the importance of simple clinical and non-invasive parameters in assessing operability among patients with left-to-right intracardiac shunts and severe PAH. However, none of the parameters were independently predictive of operative outcome. A simple AIIMS operability score based on clinical and noninvasive parameters can predict inoperability with acceptable sensitivity and specificity. However, the score should be validated in larger prospective studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/apc.apc_329_25","type":"journal-article","created":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T07:00:20Z","timestamp":1776236420000},"page":"6-13","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Outcome of congenital heart disease with left-to-right shunts and pulmonary arterial hypertension undergoing operability assessment by acute vasodilator testing: The AIIMS operability score"],"prefix":"10.4103","volume":"19","author":[{"given":"Lamk","family":"Kadiyani","sequence":"first","affiliation":[{"name":"Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anita","family":"Saxena","sequence":"additional","affiliation":[{"name":"Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sivasubramanian","family":"Ramakrishnan","sequence":"additional","affiliation":[{"name":"Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saurabh Kumar","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajiv","family":"Narang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,4,15]]},"reference":[{"key":"R1-20260420","doi-asserted-by":"crossref","first-page":"52S","DOI":"10.1378\/chest.09-2861","article-title":"Pulmonary hypertension associated with congenital heart disease: Pulmonary vascular disease: The global perspective","volume":"137","author":"Adatia","year":"2010","journal-title":"Chest"},{"key":"R2-20260420","doi-asserted-by":"crossref","first-page":"253","DOI":"10.4103\/apc.apc_153_21","article-title":"Pediatric cardiology: Is India self-reliant?","volume":"14","author":"Ramakrishnan","year":"2021","journal-title":"Ann Pediatr Cardiol"},{"key":"R3-20260420","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1136\/heartasia-2015-010645","article-title":"Surgical strategies for patients with congenital heart disease and severe pulmonary hypertension in low\/middle-income countries","volume":"7","author":"Talwar","year":"2015","journal-title":"Heart Asia"},{"key":"R4-20260420","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1017\/S1047951106000412","article-title":"Factors determining access to surgery for children with congenital cardiac disease in Guatemala, Central 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ISHLT","volume":"38","author":"Hansmann","year":"2019","journal-title":"J Heart Lung Transplant"},{"issue":"Suppl 2","key":"R8-20260420","doi-asserted-by":"crossref","first-page":"ii23","DOI":"10.1136\/heartjnl-2014-307340","article-title":"Hemodynamic assessment and acute pulmonary vasoreactivity testing in the evaluation of children with pulmonary vascular disease","volume":"102","author":"Apitz","year":"2016","journal-title":"Heart"},{"key":"R9-20260420","doi-asserted-by":"crossref","first-page":"I76","DOI":"10.1161\/01.cir.0000032875.55215.cb","article-title":"Inhaled nitric oxide as a preoperative test (INOP test I): The INOP test study group","volume":"106","author":"Balzer","year":"2002","journal-title":"Circulation"},{"key":"R10-20260420","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1093\/bja\/aem059","article-title":"Risk of cardiac catheterization under anaesthesia in children with pulmonary hypertension","volume":"98","author":"Taylor","year":"2007","journal-title":"Br J Anaesth"},{"key":"R11-20260420","first-page":"161","article-title":"Long-term outcome of patients operated for large ventricular septal defects with increased pulmonary vascular resistance","volume":"55","author":"Kannan","year":"2003","journal-title":"Indian Heart J"},{"key":"R12-20260420","first-page":"169","article-title":"Pulmonary arterial hypertension associated with congenital heart disease and Eisenmenger syndrome: Current practice in pediatrics","volume":"67","author":"Frank","year":"2015","journal-title":"Minerva Pediatr"},{"key":"R13-20260420","doi-asserted-by":"crossref","first-page":"25","DOI":"10.5334\/gh.831","article-title":"Survival of left-to-right shunt repair in children with pulmonary arterial hypertension at a tertiary hospital in a low-to-middle-income country","volume":"16","author":"Arafuri","year":"2021","journal-title":"Glob Heart"},{"key":"R14-20260420","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.21037\/tp-23-64","article-title":"Pulmonary vascular disease as a complication of pediatric congenital heart diseases","volume":"12","author":"Wacker","year":"2023","journal-title":"Transl Pediatr"},{"key":"R15-20260420","doi-asserted-by":"crossref","first-page":"00271","DOI":"10.1183\/23120541.00271-2023","article-title":"Management of systemic to pulmonary shunts and elevated pulmonary vascular resistance","volume":"9","author":"Linder","year":"2023","journal-title":"ERJ Open Res"},{"key":"R16-20260420","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1136\/heartjnl-2018-314025","article-title":"Assessment of reversibility in pulmonary arterial hypertension and congenital heart disease","volume":"105","author":"van der 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