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Intermediate- and long-term follow-up of device closure of patent arterial duct with severe pulmonary hypertension: factors predicting outcome

Published online by Cambridge University Press:  02 May 2016

Masood Sadiq ,
Asif U. Rehman ,
Najam Hyder ,
Ahmad U. Qureshi ,
Tehmina Kazmi  and
Shakeel A. Qureshi
Masood Sadiq*
Affiliation:
The Children’s Hospital, Punjab Institute of Cardiology, Lahore, Pakistan
Asif U. Rehman
Affiliation:
The Children’s Hospital, Punjab Institute of Cardiology, Lahore, Pakistan
Najam Hyder
Affiliation:
The Children’s Hospital, Punjab Institute of Cardiology, Lahore, Pakistan
Ahmad U. Qureshi
Affiliation:
The Children’s Hospital, Punjab Institute of Cardiology, Lahore, Pakistan
Tehmina Kazmi
Affiliation:
The Children’s Hospital, Punjab Institute of Cardiology, Lahore, Pakistan
Shakeel A. Qureshi
Affiliation:
Evelina London Children’s Hospital, Guy’s and St Thomas’ Trust, London, United Kingdom
*
Correspondence to: Dr M. Sadiq, FRCP, The Children’s Hospital, Punjab Institute of Cardiology, Lahore 5600, Pakistan. Tel: + 0092 42 99231723; Fax: +0092 42 99230358; E-mail: [email protected]
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Abstract

Background

In patients with large patent arterial ducts and severe pulmonary hypertension, the natural history of progression of pulmonary hypertension is very variable. Whether to close or not to close is often a difficult decision, as there are no established haemodynamic parameters predicting reversibility.

Objectives

The objectives of this study were to evaluate the results of device closure of large patent arterial ducts with severe pulmonary hypertension after 2 years of age and to determine haemodynamic variables associated with its regression during long-term follow-up.

Methods

A total of 45 patients, with median age of 10 (2–27) years, with large patent arterial ducts and severe pulmonary hypertension, were considered. Haemodynamic variables were assessed in air, oxygen, and after occlusion. The follow-up was performed to assess regression of pulmonary hypertension.

Results

Device closure was successful in 43 (96%) patients. Pulmonary artery systolic and mean pressures decreased from 79 to 67 mmHg and from 59 to 50 mmHg, respectively (p<0.001). At a median follow-up of 80 (41–151) months, severe pulmonary hypertension persisted in four (9.7%) patients. Multivariate analysis showed pulmonary vascular resistance index ⩽6 WU m2 and pulmonary artery systolic and mean pressures ⩽75 and ⩽55 mmHg (all in oxygen), having 97.8% predictive value for regression of pulmonary hypertension (p<0.001) in the long term. In 24 patients with catheterisation-based criteria, regression of pulmonary hypertension was associated with pulmonary vascular resistance index <8 WU m2 (p=0.001) and its fall of >25% (both in oxygen) (p=0.007).

Conclusions

Device closure of large patent arterial ducts with severe pulmonary hypertension is safe and effective. Pulmonary vascular resistance index and systolic and mean pulmonary artery pressures in oxygen are the key prognostic variables predicting regression of pulmonary hypertension.

Keywords

CHDcardiac catheterisationpulmonary arterial hypertensiondevice occlusionpatent arterial duct
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 1 , January 2017 , pp. 26 - 36
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Copyright
© Cambridge University Press 2016 

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