Treat-and-repair: a simple but powerful term for a complex multimodal approach in patients with pulmonary arterial hypertension associated with congenital heart disease

We would like to extend our congratulations to the paediatric task force members of the 7th World Symposium on Pulmonary Hypertension for their insightful report and recommendations in this area of critical importance [1]. We are particularly relieved to see the reintroduction of complex congenital heart disease (CHD), including segmental pulmonary hypertension (PH) [2], in the proposed PH classification. We are, however, left wondering why complex conditions with unprotected pulmonary circulation (e.g. a functional single ventricle without pulmonary stenosis) are not considered within the spectrum of Eisenmenger syndrome, as originally described by Wood [3]. It is also disappointing that adult CHD was not included as a topic in this or other reports from the World Symposium, though Ivy et al. [1] do discuss the merits of indexing pulmonary vascular resistance (PVR) in children versus adolescents and adults.