Common shunt lesions with pulmonary hypertension—who will benefit from surgery?

Left to right shunts comprise a specific group of congenital heart disease, when identified and treated on time result in excellent outcomes. However, a proportion of these defects do not receive the timely intervention and often present late posing the question of safe operability especially in low- and middle-income countries. The lack of ample evidence and standardised guidelines often poses an enigma to the treating physician preventing appropriate and patient-friendly decision-making. Moreover, no single test or clinical feature can accurately define operability in this subset of patients. In this review, we aim to address this issue in a comprehensive and holistic manner and formulate a simplified guideline based on current evidence to help the physician to arrive at an appropriate decision.

ECG, electrocardiogram; L-R left to right