Trial occlusion to assess the risk of persistent pulmonary arterial hypertension after closure of a large patent ductus arteriosus in adolescents and adults with elevated pulmonary artery pressure

Circ Cardiovasc Interv. 2014 Aug;7(4):473-81. doi: 10.1161/CIRCINTERVENTIONS.113.001135. Epub 2014 Aug 5.

Abstract

Background: No method is available to predict whether patients with patent ductus arteriosus (PDA) and severe pulmonary arterial hypertension (PAH) will show persistent postprocedural PAH (PP-PAH) after PDA closure. This study evaluated the usefulness of trial occlusion for predicting PP-PAH after transcatheter PDA closure in patients with severe PAH.

Methods and results: Trial occlusion was performed in 137 patients (age ≥12 years) with PDA and severe PAH. All patients undergoing trial occlusion had a mean pulmonary artery pressure ≥45 mm Hg, pulmonary:systemic flow (Qp/Qs) ratio >1.5, and pulmonary:systemic resistance (Rp/Rs) ratio <0.7. A total of 135 patients (98%) showing stable hemodynamics during occlusion trial underwent successful device closure. Linear correlation analysis revealed weak or moderate relationships between the baseline and post-trial pulmonary artery pressures and pulmonary:systemic pressure (Pp/Ps) ratios. Patients were followed up for 1 to 10 years (median: 5 years). PP-PAH (systolic pulmonary artery pressure >50 mm Hg by Doppler echocardiography) was detected in 17 patients (13%), who displayed no significant differences in sex and age compared with patients without PP-PAH. According to discriminant analysis, the strongest discriminators between patients with and without PP-PAH were the baseline left ventricular end-diastolic volume and the baseline and post-trial systolic Pp/Ps ratios. In particular, a post-trial systolic Pp/Ps ratio >0.5 correctly classified 100% of the PP-PAH and non-PAH patients.

Conclusions: Trial occlusion is a feasible method to predict PP-PAH in patients with PDA and severe PAH. A post-trial systolic Pp/Ps ratio >0.5 indicates a high risk of PP-PAH occurrence after device closure.

Keywords: ductus arteriosus, patent; hypertension, pulmonary.

MeSH terms

  • Adolescent
  • Adult
  • Ductus Arteriosus, Patent / diagnosis*
  • Ductus Arteriosus, Patent / surgery
  • Female
  • Follow-Up Studies
  • Hemodynamics
  • Humans
  • Hypertension, Pulmonary / diagnosis*
  • Hypertension, Pulmonary / etiology
  • Hypertension, Pulmonary / prevention & control
  • Male
  • Middle Aged
  • Postoperative Complications / diagnosis*
  • Postoperative Complications / prevention & control
  • Predictive Value of Tests
  • Preoperative Care
  • Prognosis
  • Pulmonary Artery / pathology
  • Pulmonary Artery / surgery*
  • Retrospective Studies
  • Septal Occluder Device / statistics & numerical data
  • Treatment Outcome
  • Vascular Surgical Procedures*
  • Young Adult