Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2012 Jul;5(2):135-40.
doi: 10.4103/0974-2069.99614.

Transcatheter closure of large patent ductus arteriosus with severe pulmonary arterial hypertension: Short and intermediate term results

Parag S Bhalgat  1 , Robin Pinto, Bharat V Dalvi
Affiliations

Transcatheter closure of large patent ductus arteriosus with severe pulmonary arterial hypertension: Short and intermediate term results

Parag S Bhalgat et al. Ann Pediatr Cardiol. 2012 Jul.

Abstract

Objective: To assess the efficacy and safety of transcatheter closure (TCC) of patent ductus arteriosus (PDA) with severe pulmonary arterial hypertension (PHT).

Background: TCC of small and moderate-sized PDAs is well established. However, there is a paucity of data on TCC of large PDA with severe PHT.

Methods: This is a retrospective observational study of 76 patients with large PDA and severe PHT who were referred for TCC. Multiple clinical and investigational parameters were evaluated to decide the reversibility of PHT. Following the TCC, patients were serially followed up to assess the efficacy and safety of closure and its impact on PHT.

Results: Of 76 patients, nine were found to have PDA with Eisenmenger's syndrome. Of remaining 67, two were thought to have irreversible PHT based on hemodynamic data obtained after balloon occlusion of the duct. Sixty five patients, who eventually underwent TCC of PDA, had a median age of 9.1 years (range 1 month to 40 years). The weight ranged between 2.5 to 62 kg (median 14 kg). The PDA size was 9.1 ± 4.6 mm. The mean systolic pulmonary artery pressure was 66.9 ± 15.3 mm Hg. Duct occluder was used in 63 and muscular ventricular septal defect closure device in 2. The follow up was available in 56 (86%) with a mean follow up period of 65 ± 34 months. All the patients had complete closure of the PDA at 6 months follow up. Mild obstruction of left pulmonary artery (n=3) and aortic isthmus flow (n=6) was noted at the time of discharge. During the follow up, partial or complete resolution of PHT was observed in all the patients in whom Doppler-derived right ventricular systolic pressure was recorded (available in 40 of 56 patients).

Conclusions: TCC of large PDA with severe PHT and significant left to right shunt was found to be effective and safe in the short and intermediate term.

Keywords: Congenital heart disease; device closure; hemodynamics; pediatric intervention.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest: None declared

Figures

Figure 1
Figure 1
(a) Shows test occlusion of PDA with a sizing balloon. (b) Shows a simultaneous recording of pressures from the aorta and the pulmonary artery. Balloon inflation dropped the pulmonary artery pressure by > 20% suggesting reversibility of pulmonary vascular resistance
Figure 2
Figure 2
(a) A large PDA was profiled better in the lateral projection than in the (b) RAO view. In the latter, the PDA tended to get significantly foreshortened
Figure 3
Figure 3
(a) Angiogram in the RAO projection delineated the duct better than in the (b) lateral view. In the lateral view, a significant length of the PDA got superimposed by the descending thoracic aorta
Figure 4
Figure 4
ECG and aortic pressure of an infant at baseline (a) and after crossing of duct with wire (b). Note the significant drop in systolic pressure along with ST elevation in inferior leads after the PDA was crossed with a super-stiff guide wire
See this image and copyright information in PMC

References

    1. Moore P, Brook M, Heymann M. Patent ductus arteriosus and aortopulmonay window. In: Allen H, Driscoll D, Shaddy R, Feltes T, editors. Moss and Adams’ Heart disease in infant children and adolescent. 7th ed. Philadelphia: Lippincott Williams and Wilkins; 2008. pp. 683–702.
    1. Yang SW, Zhou YJ, Hu DY, Liu YY, Shi DM, Guo YH, et al. Feasibility and safety of transcatheter intervention for complex patent ductus arteriosus. Angiology. 2010;61:372–6. - PubMed
    1. Yan C, Zhao S, Jiang S, Xu Z, Huang L, Zheng H, et al. Transcatheter closure of patent ductus arteriosus with severe pulmonary arterial hypertension in adults. Heart. 2007;93:514–8. - PMC - PubMed
    1. Masura J, Walsh KP, Thanopoulous B, Chan C, Bass J, Goussous Y, et al. Catheter closure of moderate-large sized patent ductus arteriosus using the new Amplatzer duct occluder: immediate and short-term results. J Am Coll Cardiol. 1998;31:878–82. - PubMed
    1. Balzer DT, Kort HW, Day RW, Corneli HM, Kovalchin JP, Cannon BC, et al. Inhaled Nitric Oxide as a Preoperative Test (INOP Test I): the INOP Test Study Group. Circulation. 2002;106(12 Suppl 1):176–81. - PubMed