Objective To study the role of survivin in the incidence of pulmonary hypertension secondary to congenital heart disease (CHD) of left-to-right shunt.   Methods  Forty-nine cases were divided into 4 groups according to mean pulmonary artery pressure (mPAP)

that is

non-hypertension group

mild hypertension group

medium hypertension group

and severe hypertension group. Their lung tissue samples were collected during heart surgery. TUNEL technique and immunohistochemical analysis were respectively used to detect nuclear DNA fragment of apoptotic cells and the expression of survivin

bcl-2 and bax. Western blotting also was conducted to detect survivin expression.   Results  The pulmonary wall of CHD patients with medium or severe pulmonary hypertension became significant incrassate. The apoptotic index and expression level of bax were significantly decreased but surviving and bcl-2 expressions were significantly increased in CHD with medium or severe pulmonary hypertension. Survivin expression was significant correlation with percentage media wall thickness and apoptotic index.   Conclusion  Apoptosis associated with survivin plays an important role in pulmonary artery remodeling after pulmonary hypertension of CHD.