PAH Operability Assessment in Bengaluru
A careful catheter-based assessment of lung pressures and resistance to decide whether a heart defect can still be safely repaired in children with severe pulmonary hypertension. Under the care of Dr. Bharath A. P.
- Direct PA Pressure Measurement
- Pulmonary Vascular Resistance
- Oxygen / Vasodilator Testing
- Clear Repair Decision
Dr. Bharath A. P.
Pediatric Interventional Cardiologist
Clinical Practice
Dedicated to newborn & child cardiac excellence
Children Evaluated
Evaluated with echocardiogram, from preterm infants to young adults
Children Operated
Cardiac interventions & cath lab procedures in children
Surgeries Coordinated
Coordinated surgical care for children with congenital heart diseases.
Why Does Pulmonary Hypertension Affect Repair?
Large holes in the heart — such as a VSD, PDA or AVSD — send extra blood at high pressure into the lungs. If not treated in time, the lung blood vessels can thicken and stiffen, a condition called pulmonary arterial hypertension (PAH). Over time, the damage may become irreversible.
When PAH is severe, closing the defect is only helpful if the lung vessels can still relax. Catheterisation measures pulmonary artery pressure, blood flow and pulmonary vascular resistance, and tests how the vessels respond to oxygen or vasodilators. These results help decide whether repair will help or harm your child.
Precise Numbers
Flow ratio (Qp:Qs) and pulmonary vascular resistance are calculated from direct measurements.
Vasoreactivity
Response to 100% oxygen and/or inhaled nitric oxide shows whether the lung vessels can relax.
Balanced Decision
Results guide repair, a staged 'treat-and-repair' approach or medical management.
When Is It Recommended?
This assessment is advised when a child with a heart defect has:
- Severe pulmonary hypertension on echocardiography
- A large VSD, PDA, AVSD or ASD diagnosed late
- Bidirectional or reversed shunting across the defect
- Lower-than-expected oxygen saturations
Not sure if your child needs this?
Share your child's reports and Dr. Bharath's team will guide you on the next step.
Conditions Covered
Heart conditions commonly assessed or treated with this service.
Large VSD
Unrestrictive ventricular septal defects presenting late.
Large PDA
Ducts causing high-pressure flow into the lungs.
AVSD
Atrioventricular septal defects, common in Down syndrome.
ASD with PAH
Atrial defects with unusually high lung pressures.
Complex Shunts
Truncus arteriosus, aortopulmonary window and similar lesions.
Eisenmenger Physiology
Advanced disease where closure is no longer beneficial.
How It Is Performed
What happens on the day, explained simply so you know what to expect.
- 1Step 01 / 05
Echo & Clinical Review
Oxygen saturations, echo findings and symptoms are reviewed in detail.
- 2Step 02 / 05
Catheter Access
Under sedation or anaesthesia, catheters are placed via the groin vessels.
- 3Step 03 / 05
Baseline Measurements
Pressures and oxygen saturations are recorded to calculate flow and resistance.
- 4Step 04 / 05
Vasoreactivity Testing
Measurements are repeated while breathing oxygen and/or inhaled nitric oxide.
- 5Step 05 / 05
Shared Decision
Results are discussed with the family and the surgical team to choose the best path.
Benefits, Risks & Care
A balanced overview, plus how to prepare and what recovery looks like.
Key Benefits
- Prevents harmful surgery in inoperable cases
- Identifies children who can still benefit from repair
- Guides PAH medicines and staged strategies
- Objective data for a confident family decision
Every child is different. Specific risks, benefits and alternatives for your child are discussed in detail during consultation.
Why Families Choose Dr. Bharath A. P.
Super-speciality training, academic experience and hands-on cath lab expertise.
National Board super-speciality fellowship at Madras Medical Mission Hospital, Chennai.
Assistant Professor of Pediatric Cardiology at Sri Jayadeva Institute of Cardiovascular Sciences and Research since 2015.
Diagnostic catheterisation and interventions including ASD, VSD and PDA closures, valvuloplasties and stenting.
Co-author of peer-reviewed articles in Heart Lung Circulation, Archives of Disease in Childhood and Annals of Pediatric Cardiology.
Frequently Asked Questions
Answers to common questions about Assessment of Operability in Children with Severe Pulmonary Arterial Hypertension (PAH).
Why can't the hole simply be closed?
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In advanced pulmonary hypertension, the hole may act as a 'pressure release valve' for the right side of the heart. Closing it when the lung vessels are severely damaged can make the child worse. Catheterisation helps determine whether closure is safe.
What does 'borderline operable' mean?
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Some children fall between clearly operable and inoperable. They may benefit from PAH medicines followed by reassessment, or from partial or fenestrated closure. The approach is individualised.
Can pulmonary hypertension be prevented?
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Yes, in most cases. Timely closure of large defects — often in the first year of life — prevents permanent lung vessel damage. Early evaluation of any child with a large shunt is important.
What if my child is found to be inoperable?
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Children who are not suitable for closure are managed with specific PAH medicines and regular follow-up, which can improve symptoms and quality of life.
Is the vasoreactivity test painful?
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No. The test is done during the same catheter procedure under sedation or anaesthesia. Your child simply breathes oxygen or nitric oxide while measurements are repeated.
Will my child need medicines before or after closure?
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Some children with borderline results are given pulmonary hypertension medicines before closure, and some continue them afterwards. The plan depends on the catheter findings and follow-up echo.
Visit the Clinic
VEGA CURRE Multispeciality Clinic
2nd Floor, Shop No. 24 & 25, 3rd A Cross, Bhuvaneshwari Nagar, Dasarahalli Main Road, Hebbal Kempapura, Bengaluru – 560024