Application Of Transthoracic Echocardiography To Assess The Therapeutic Effects In Adult Patent Ductus Arteriosus With Severe Pulmonary Hypertension After Interventional Occlusion

Objective:To essess the changes of cardiac morphology, ventricular function and pulmonary pressure after interventional occlusion by transthoracic echocardiography (TTE) in adult patent ductus arteriosus (PDA) with severe pulmonary hypertension.Method:This is a retrospective observational study of 40 adult patients diagnosed PDA with severe pulmonary hypertension who were referred for interventional occlusion,7 of them combined with non-restriction VSD accepted hybrid procedure, those who with Eisenmenger Syndrome(ES) and extremely severe pulmonary hypertension patients accepted "targeted drugs-surgery". The index of preocclusion and postocclusion in 24 hours,1 months,3 months,6 months,1 years,2 years by TTE including:left atrium end-systolic diameter(LAESD), left ventricular end-diastolic diameter (LVEDD), right ventricular diastolic diameter(RVEDD), main pulmonary artery diameter (MPAD), left ventricular ejection fraction(LVEF), stroke volume(SV), left ventricular end-diastolic volume(LVEDV) were measured. Pulmonary artery systolic or mean pressures was estimated According the regurgitation velocity of tricuspid or pulmonary valve.Results:LAESD, LVEDD, RVEDD, MPAD, SV and EDV in adult PDA with severe pulmonary hypertension undergoing interventional occlusion in 24 hours,1 month,3 months,6 months,1 year and 2 years were decreased compared with preocclusion. LAESD, LVEDD, MPAD, SV and EDV in 1 months,3 months,6 months,1 years,2 years after occlusion were decreased compared with postocclusion for 24 hours. LAESD, LVEDD and MPAD after post occlusion for 3 months,6 months,1 years and 2 years were decreased compared with postocclusion for 1 months. The differences were statistically significant (P<0.05). There is no significant difference in LVEF at 24 hours,1 month,3 months and 6 months after occlusion compared with preocclusion (P >0.05). But there is a significant difference in LVEF between preocclusion, postocculusion for 24 hour,1 month and 1 year (P<0.05). LVEDD, RVEDD, MPAD, SV and EDV of PDA combined with VSD were decreased before VSD repair.2. The rate of normal and mild pulmonary hypertension was increased gradually over time in adult patients diagnosed PDA with severe pulmonary hypertension after occlusion (P<0.05), while the rate of moderate and severe pulmonary hypertension was decreased (P<0.05). Of 7 PDA with VSD patients, 3 had completed hybrid procedure, one dropped to mild pulmonary pressure, and two dropped to moderate pulmonary pressure after VSD repair. The other four had completed PDA occlusion, but had not undergone VSD repair, to the end of the follow-up were severe pulmonary hypertension.Conclusions:1. interventional occlusion of PDA with reversible severe pulmonary hypertension the short and intermediate term results were satisfied. The long-term effects remain to be proved through follow-up.2. The patients with ES may benefit from "targeted drugs-surgery" and hybrid procedure.3. Pulmonary vascular disease still continued to develop seriously in a small number of patients with severe pulmonary hypertension after interventional occlusion, and pulmonary hypertension existed persistently.4. TTE is the first choiced to follow up after operation. It plays an important guiding role in clinical for evaluating the prognosis of PDA with severe pulmonary hypertension. It can observe the changes of cardiac morphology, ventricular function and pulmonary pressure after interventional occlusion termly.