IMMEDIATE RESULTS OF DEVICE CLOSURE IN HYPERTENSIVE PATENT DUCTUS ARTERIOSUS

Abstract

ABSTRACT:
OBJECTIVE: To assess the mean pulmonary artery pressures (PAP) in patients with large Patent Ductus Arteriosus (PDA) with ‘reversible pulmonary hypertension’ before and after the device closure.
MATERIAL AND METHODS: This descriptive retrospective study was carried out at CPE Institute of Cardiology, Multan, Pakistan from 2007 to June 2019. Patients who had large PDA with pulmonary hypertension (PH) were included. Mean PAP > 50% of mean aortic pressure was considered as pulmonary hypertension. Reversibility of PH was based on clinical criterial. Patients with room air saturation > 93%, cardiomegaly on chest x-ray with lung arterial vascularity extending into the lateral one third of the lung fields were considered to have reversible pulmonary hypertension. Patients with weight <8 kg and age < 2 year were excluded.
Out of 556 patients who had undergone PDA device closure, 98 had fulfilled our inclusion criteria. Mean age was 8 ±7.5 (2.5 – 45) years. Mean weight was 19.5 ±13.2 (7-66) kg. Mean diameter of PDA was 6 mm. Mean PAP decreased from 59 ± 12 mmHg to 30 ± 7 (p< .001) after device closure. Duct occluders were used in 92 patients (97.9%), while 2 had muscular VSD device (2.1%). In 2 patients, there was underestimation of the size of PDA so the device was retrieved and replaced with large one. Procedure remained unsuccessful in 2 patients because the device dropped into main pulmonary artery before it was released. Larger size device was not available at that time so the patients were referred for surgery. The duct occluder devices embolized partially in 2 patients which were referred for the surgical removal of the devices and PDA ligation.
Post procedure echocardiogram performed next day showed no residual PDA in all out patients. There was pulse loss in lower limb in 8 patients which was treated successfully with heparin infusion with no residual damage. Mild obstruction is documented in left pulmonary artery (n=6). None of our patients had high PAP after the device closure.
CONCLUSION: Device closure is safe and effective in closure of hypertensive PDA using clinical criteria. Follow up study is required to reinforce these findings.
KEY WORDS: Congenital heart disease, PDA, device closure, pulmonary hypertension, hypertensive PDA