How to Treat Pulmonary Hypertension Combined with Precocious Heart Disease? As a front-line doctor in the Department of Pediatric Cardiac Surgery at Beijing Fu Wai Hospital, Li Pingyuan often sees patients with simple precardiac diseases: atrial septal defect, ventricular septal defect and patent ductus arteriosus, etc. Due to various reasons such as family financial reasons, parents and grandparents with little knowledge of science, timely surgical treatment is delayed, resulting in patients with pulmonary hypertension, which cannot be operated or brings unnecessary surgical treatment. risk. The result is that a simple congenital heart disease, which can become normal with surgery before the age of five, develops into a complicated situation such as inoperable or requiring appropriate medication. This has an unnecessary impact on the patient himself, his family and even society. It is often deeply regrettable and distressing to see this situation. In recent years, with the promotion of the treatment of precardiac disease and the introduction of various drugs for the treatment of precardiac disease combined with pulmonary hypertension, the diagnosis, observation and treatment of precardiac disease combined with pulmonary hypertension have made great progress. An increasing number of patients with prematurity combined with pulmonary hypertension, especially those with prematurity combined with severe pulmonary hypertension who have lost the chance of surgery, are even able to obtain the goal of surgical eradication of cardiac malformations after giving drugs to reduce pulmonary artery pressure, and even though pulmonary hypertension may occur in the future due to pulmonary vascular damage and lesions, at least the life expectancy of the patients can be prolonged, and this result has been a boon for many patients. I will now talk about how to treat precardiac disease combined with pulmonary hypertension: (a) Etiological treatment: This is the direct correction of cardiac malformations, that is, the timely surgical treatment of precardiac disease in the early stages of its detection. This is the best means to intercept the occurrence of pulmonary hypertension from the root cause. It is mainly used in cases of prediabetes combined with pulmonary hypertension of the power type, which generally means mild to moderate pulmonary hypertension. However, in patients with very high pulmonary artery resistance and right-to-left shunts, correction of cardiac anomalies not only fails to reduce pulmonary artery pressure, but may cause a dramatic increase in pulmonary artery pressure or even sudden death. In addition, for some patients with severely elevated pulmonary artery pressure but still have predominantly left-to-right shunts, the use of participation or surgical means to gradually reduce the left-to-right shunt is also a means that can be considered. (ii) Pharmacological treatment: This is the only option for patients with preexisting cardiac disease combined with pulmonary hypertension who have lost the opportunity for surgical treatment. Drug therapy can reduce or reverse pulmonary hypertension and achieve a life-prolonging effect. Traditional medical therapy is usually used, by means of oxygen, drugs such as diuretics, digoxin and warfarin anticoagulation. This is due to the fact that oxygen inhalation reduces pulmonary vasospasm, decreases pulmonary vascular resistance, and has little effect on the body circulation. While the use of diuretics and digoxin drugs can improve the patient’s cardiac function, anticoagulation therapy can prevent the formation of pulmonary artery thrombosis in situ. (iii) Combination therapy: Two means are included, namely the combination of drugs and medications and the combination of drugs plus surgery. It can be said that theoretically the combination therapy of drugs can obtain better efficacy, such as alleviating the side effects of excessive measurement of a single drug species, but because of the short history of drug therapy, it is still in the stage of research and observation. As for the combination of drug and surgery, this requires the use of drugs followed by surgery or surgery followed by drug therapy depending on the patient’s pulmonary hypertension. In China, there are some reports of combined drug-surgery treatment, and the results are optimistic according to the relevant data. (iv) Other treatments: atrial septostomy is a palliative procedure that can only delay the progression of pulmonary hypertension. Lung transplantation and heart-lung transplantation have been maturely applied abroad in the treatment of patients with pulmonary hypertension, mainly for patients who have been adequately treated medically without significant results. Lung transplantation can prolong the patient’s life and improve quality of life, but only for end-stage patients. Treatment under investigation: Various cytokines including platelet-derived factor, fibroblast trophoblast factor and epithelial trophoblast factor have been found to be involved in the abnormal proliferation and migration of vascular smooth muscle cells and have an important role in reversing pulmonary vascular remodeling. Vasoactive intestinal peptides may relax vascular smooth muscle cells by acting on cAMP and cGMP and may also interfere with platelet aggregation. New drugs in the angiopoietin and 5-monohydroxytryptamine pathways are also being tested in animals. Transfer of the NO synthase gene to lung tissue of rats with hypoxic pulmonary hypertension resulted in an increase in pulmonary arterial NO and a decrease in pulmonary hypertension. Calcitonin gene-related peptide is a diastolic substance in vivo, and transfer of calcitonin gene-related peptide gene to lung tissue epithelium by adenovirus was effective in reducing pulmonary artery pressure. The combination of endothelial trophoblast, which can reduce pulmonary artery pressure, and endothelial precursor cell transplantation, which has a satisfactory effect, is even more effective in reducing pulmonary artery pressure. In summary, the fundamental treatment for precordial disease is surgical correction of the heart’s vascular malformation, thus eliminating the pathophysiological changes caused by the malformation, which means that treatment of the cause is the key. This surgery often involves incision of the heart and requires hypothermic anesthesia or extracorporeal circulation. The preschool years are the appropriate age for surgery, but surgery can be performed in infancy in severe cases or when necessary. Infants or children who cannot tolerate corrective surgery may undergo palliative surgery to partially improve their pathophysiology and create the conditions for later corrective surgery. Patients who have not undergone surgery are advised to avoid overexertion, prevent infection, and pay attention to personal hygiene to avoid heart failure, infective endocarditis, or thromboembolism, depending on their condition. It can be said that precardiac disease combined with pulmonary hypertension is not considered a terminal disease, but patients with precardiac disease and their families for the treatment of precardiac disease must not have a fluke mentality. According to the results of the follow-up of patients with prediabetes combined with pulmonary hypertension, the treatment effect is significantly worse compared to that of prediabetes alone. Therefore, precardiac disease must be treated in a timely manner, especially in cases of precardiac disease combined with pulmonary hypertension need to be treated before it is too late. As a front-line clinician, I feel sorry for children who lose their chance for surgery every time! I hope these articles will help parents who are still confused and hesitant to make the right decision and give their children early examination and treatment, so as to give them a brighter life as possible!