Keiichi Hirono, Keiko Uchida, Taku Ishii, Hidekazu Ishida, Shinichi Takatsuki, Hiroyuki Fukushima, Kei Inai, Susumu Hosokawa, Reina Ishizaki, Hirofumi Sawada, Naofumi F. Sumitomo, Ayako Chida-Nagai, Yuichi Ishikawa, Hirohiko Motoki, Atsushi Yao, Shigetoyo Kogaki, Hiroyuki Yamagishi, Shozaburo Doi
Toyama University Hospital. Tokyo Medical University. Institute of Science Tokyo. Osaka University Graduate School of Medicine. Toho University, Omori Medical Center. Tokyo Women’s Medical University. Japanese Red Cross Musashino Hospital. Keio University. Mie University. Hokkaido University Hospital. Chigasaki Kanazawa Internal Medical Clinic. Shinshu University. University of Tokyo. Osaka General Medical Center. Tokyo Metropolitan Children’s Medical Center.
Japan
Journal of Clinical Medicine
J Clin Med 2026; 15:
DOI: 10.3390/jcm15031087
Abstract
Background: Pulmonary atresia (PA) with ventricular septal defect (VSD) and major aortopulmonary collateral arteries (MAPCAs), a life-threatening congenital heart defect (CHD), is frequently associated with abnormal pulmonary blood flow and vascular remodeling, causing hypoxia and heart failure. Segmental pulmonary hypertension (PH), a distinct PH type, may exist in some patients. Pulmonary vasodilators have been considered for treatment; however, evidence of their efficacy and safety remains lacking.
Methods: A systematic review was conducted using PubMed, MEDLINE, The Cochrane Library, and Ichushi Web, encompassing studies from inception to May 2023. Inclusion criteria focused on patients with PA/VSD/MAPCAs treated with PH medications.
Results: Of 86 studies screened, 6 met the inclusion criteria, including 1 cohort study and 5 case reports, comprising 22 patients. The most frequently administered medications were sildenafil (14 cases) and bosentan (12 cases), with 16 patients receiving monotherapy. Clinical improvements were observed in pulmonary vascular resistance (8/8 patients), oxygen saturation (8/19 patients), and symptoms (19/21 patients). Adverse effects were noted in five patients, including treatment discontinuation in two.
Conclusions: PH medications may benefit some patients with PA/VSD/MAPCAs; however, the extremely limited sample size (n = 22) and substantial heterogeneity in anatomy, age, surgical status, and treatment regimens severely limit interpretability and clinical applicability. Considering the potential benefits and risks associated with these medications, their use should be considered cautiously and restricted to specialized centers with expertise in CHD and PH management.
Category
Class I. Pulmonary Hypertension Associated with Congenital Cardiovascular Disease
Segmental Pulmonary Arterial Disease
Medical Therapy. Efficacy or Lack of Efficacy
Medical Therapy. Adverse Effects or Lack of Adverse Effects
Age Focus: Pediatric Pulmonary Vascular Disease or Adult Pulmonary Vascular Disease
Fresh or Filed Publication: Fresh (PHresh). Less than 1-2 years since publication
Article Access
Free PDF File or Full Text Article Available Through PubMed or DOI: Yes