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Heart. 2018 Nov 22. pii: heartjnl-2018-314025. doi: 10.1136/heartjnl-2018-314025. [Epub ahead of print]

Assessment of reversibility in pulmonary arterial hypertension and congenital heart disease.

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Center for Congenital Heart Diseases, Department of Pediatric Cardiology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Division of Cardiology, Department of Pediatrics, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands.
Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.


Pulmonary arterial hypertension (PAH) in congenital heart disease (CHD) can be reversed by early shunt closure, but this potential is lost beyond a certain point of no return. Therefore, it is crucial to accurately assess the reversibility of this progressive pulmonary arteriopathy in an early stage. Reversibility assessment is currently based on a combination of clinical symptoms and haemodynamic variables such as pulmonary vascular resistance. These measures, however, are of limited predictive value and leave many patients in the grey zone. This review provides a concise overview of the mechanisms involved in flow-dependent progression of PAH in CHD and evaluates existing and future alternatives to more directly investigate the stage of the pulmonary arteriopathy. Structural quantification of the pulmonary arterial tree using fractal branching algorithms, functional imaging with intravascular ultrasound, nuclear imaging, putative new blood biomarkers, genetic testing and the potential for transcriptomic analysis of circulating endothelial cells and educated platelets are being reviewed.


cardiac imaging and diagnostics; congenital heart disease; pulmonary vascular disease; translational cardiovascular science; vascular biology

Conflict of interest statement

Competing interests: None declared.

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