Document Type : Original Article

Authors

1 Department of Pediatric Cardiology, College of Medicine, Babylon University, Babylon, Iraq.

2 Department of Pediatric Cardiology, College of Medicine, Kufa University, Najaf, Iraq.

3 Department of Cardiothoracic surgery, Shaheed Almehrab cardiac surgery and catheterization, Babylon, Iraq

10.22038/ijn.2023.72793.2411

Abstract

Transcatheter closure is the most common treatment for patent ductus arteriosus (PDA), but managing large PDA is difficult because there are few devices for closure and surgical treatment is risky, especially in young infants with low weight and adults with calcified PDA. This research examines transcatheter closure and PA pressure reversibility in large PDA with severe pulmonary hypertension (PHT). A prospective research examined high PA pressure in 34 patients with big PDA and severe PHT who were closed with various occludes. Clinical and TTE follow-up at 4 weeks, 3 months, 6 months, and 12 months post-closure measured PA pressure and closure effectiveness. 34 big PDAs with significant PHT were transcatheter-closed in 723 individuals. Patients were a few months old to adults and weighted 4.25 to 61kg. ADO1, MVSD, AVP2, ASDO, and a stent closed PDAs. After intervention, the PA systolic, mean, and diastolic pressures were 36.85 ± 11.12mmhg, 29.24 ± 10.09mmhg, and 23.35 ± 8.82 mmhg, respectively. After intervention, the aortic systolic, mean, and diastolic pressures were (112.38 ± 16.97mmhg), (76.00 ± 9.73mmhg), and (61.88 ± 8.73mmhg). Two instances showed rebound PA pressure 3 months after effective treatments that did not respond to pulmonary vasodilator therapy. The median size of PDA in 10 cases closed by MVSD was 11.59 ± 3.15mm and the device size was 16.20 ± 3.46mm, the defect size in 15 cases closed with ADO I device was 9.19 ± 3.46mm and the median size of occluder was 11.07 ± 4.06mm, and in 4 cases, the median size was 5.15 ± 0.65mm, mostly in infants closed by AVP2 occluder with device size 8.50 ± 1.00mm. Trans catheter closure of large PDA with severe PHT using off-labeled device is effective. Meticulous, continuous assessment and evaluation of PHT response for closure is mandatory to confirm longstanding efficacy and safety.

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