Pulmonary manifestations of congenital heart disease in children

14 Oct 2022 11:25 11:50

Sharing the same body cavity, the heart and lungs are closely interconnected by the pulmonary vasculature. Cardiac and pulmonary patho-physiologies are closely interdependent, which makes the management of patients with congenital heart disease (CHD) more complex.

Congenital heart disease (CHD) imparts consequences to the airway, respiratory system mechanics, pulmonary vascular system, and lymphatic system. An increase or decrease in pulmonary vascular pressures leads to changes in the blood vessels, which directly affect the airways, lung interstitium, alveoli, and pleura. CHD often leads to respiratory failure as a result of its impact on gas exchange, water/solute exchange, and pulmonary mechanics. The appearance of lung disease secondary to cardiac disease depends on whether the changes in the pulmonary vascular pressures are acute or chronic.

Meanwhile, alterations in pulmonary blood flow associated with CHD can cause abnormalities in pulmonary mechanics and limitation of exercise. Another concern is abnormal formation or enlargement of great vessels can compress airways and cause large and small airway obstructions. CHD can also lead to pulmonary arterial hypertension. While lymphatic abnormalities associated with CHD can cause pulmonary edema, chylothorax, or plastic bronchitis. Clinical manifestations of cardiac disease include pulmonary edema, pleural effusion, hypoxemia, pulmonary hypertension, atelectasis and trachea-bronchomalacia.

Understanding how the cardiovascular system has an impact on pulmonary growth and function can help determine options and timing of intervention.