The Follow-up Study On Interventional Therapy Of Patent Ductus Arteriosus Patients With Severe Pulmonary Hypertension

Objective:Pulmonary arterial hypertension is a serious disease which threatens human health and life. According to conservative estimates, there are about13million patients with pulmonary hypertension in China. Pulmonary hypertension is divided into two types:primary and secondary. Congenital heart diseases are the common causes of secondary pulmonary hypertension and patent ductus arteriosus (PDA) is one of the most common diseases of congenital heart disease. Interventional closure of patent ductus arteriosus with mature technology, can basically replace most of surgical operation. This study was designed to evaluate the feasibility and immediate to mid term outcomes of CHD interventional closure in strictly selected patients of PDA with severe pulmonary hypertension.Methods:From July2003to July2012, twenty eight patients of PDA associated with severe pulmonary artery hypertension (6men,22women) underwent attempted transcatheter closure of PDA at a average age of17.5±8.7years (11～48years). Transthoracic echocardiography suggests the presence of left ventricular expanded in25patients and normal left ventricular size in3patients. The patients’ clinical manifestations, hemodynamic data and the reaction on closure test those determine the final PDA closure or not. Electrocardiograms and echocardiograms were used for follow-up evaluation of the treatment after successful PDA closure. Data were expressed as mean±standard deviation.Results:In28patients,26cases achieved successful PDA closure,2cases give up, total of24PDA occluder devices and2pieces of muscular ventricular septal occluder were used. Descending aorta angiography showed PDA a funnel type in18cases, window type in7cases,3cases of tubular type. The minimum PDA diameter of successful transcatheter closure patients was 6.6±4.2(5-12) mm, the deployed occluder diameter (aortic side) was13.3±3.6(10-24) mm. Average follow-up time was11.5±8.4(1-36) months. The pulmonary artery systolic pressures of immediate after procedure and follow-up was significantly decreased than that of pre-operation (82.4±9.8mmHg vs.51.6±12.6mmHg, P=0.000and82.4±9.8mmHg vs.46.4±9.3mmHg, P=0.000). Four cases of pulmonary artery pressure changed to normal,11cases changed to mild,9cases changed to moderate and2patients still had severe pulmonary hypertension. Left atrial diameter, left ventricular end-diastolic diameter and pulmonary artery diameter decreased significantly compared with those of preoperative. Left ventricular ejection fraction showed no significant change. Mitral regurgitation, tricuspid regurgitation, aortic regurgitation and pulmonary valve regurgitation eased in some degrees at follow-up time. Three patients were found with postoperative residual shunt, of which1residual shunt disappeared before discharge,1residual shunt disappeared at one month, and there was still a small residual shunt in another patients12months after procedure. During follow-up, no sudden death, occluder malposition or migration, mechanical hemolysis, infective endocarditis and thromboembolic complications occurred.Conclusions Transcatheter closure of PDA in some strictly selected patients with severe pulmonary hypertension, its short to mid-term results showed safe and effective, its long-term efficacy remains to be further study.