Therapeutic Evaluation Of Transcatheter Closure Of PDA With Severe Pulmonary Arterial Hypertension In Adults

Objectives To investigate the application of self-expandable occluders for transcatheter closure of patent ductus arteriosus (PDA) associated with severe pulmonary arterial hypertension in adults, and the assessment of immediate and mid-term results.Methods:24 adults with PDA associated with severe pulmonary arterial hypertension (4men,20women) underwent attempted transcatheter closure of PDA at a age of 27.7(8.1) years (range 19-45 years) from January 2002 to February 2011 in our hospital.Based on haemodynamic and clinical data that obtained before and after trial occlusion,the final duct occlusion was determined and carried out. Electrocardiograms and echocardiograms were used for follow-up evaluation of the treatment after successful closure.Results:1.23 of the 24 patients had successful occlusion, and 1 patient failed.2. In 23 patients which occlusion was successful, systolic pulmonary arterial pressure decreased markedly after trial occlusion [(54.87±19.24) mmHg VS.(96.09±23.08) mmHg,P<0.05]; Mean pulmonary arterial pressures decreased significantly after trial occlusion [(39.17±14.81) mmHg VS.(72.87±15.77) mmHg, P<0.05].3.Follow-up 1-52 months, average 11.5 months in patients which occlusion was successful, the dimensions of the left atrium, left ventricle and pulmonary artery increased considerably in follow-up compared with those of preocclusion.4.The occlusion was not successful in 1 patient, pulmonary arterial pressures increased after trial occlusion, but aortic pressure decreased obviously,and the patient showed worsening of symptoms combining with bradycardia and obnubilation.The aortic pressure increased,meanwhile the heart rate and the mind recovered withdrawing the PDA occluder. Repeat still appeared afore-mentioned symptoms, hence gave up.Conclusions:Transcatheter closure is a safe and effective treatment for adults with PDA associated with reversible severe pulmonary arterial hypertension. The assessment of immediate and mid-term results were good. Further research is needed for the evaluation of long-term results.