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ASSA13-15-6 Transcatheter Closure of Patent Ductus Arteriosus with Severe Pulmonary Hypertension Using Domestic Occluder in Adults
  1. Han Xiumin,
  2. Zhu Xianyang,
  3. Zhang Duanzhen
  1. Shenyang Northern Hospital

Abstract

Background To evaluate the clinical efficacy of transcatheter closure of patent ductus arteriosus (PDA) with severe pulmonary hypertention using domestic occluder in adults.

Methods From July 2000 to July 2011.82 adult patients (13 male, 69 females) were treated by transcatheter closure with domestic occluder. Patients mean age was 36.6years (ranging 18 to 60 years) and the mean PDA diameter at its narrowsest segment was (9.6 ± 2.6) (ranging 6.0 to 16.0) mm. 6 patients of them were treated with sildenafil and/or bosentan before PDA closure. All patients accepted contrast examination of aorta arch-descendens before transcatheter treatment. Patients were classified according to Krichenko grouping method, type A consisted of 35 patients, type B consisted of 4, type C 40 cases, and type E 3 cases. Duct occluder was used in 58, atrial septal defect closure device in 3 and muscular ventricular septal defect closure device in 5. The achievement of permanent transcatheter closure was decided according to the change of the pulmonary arterial pressure, aortic pressure and oxygen saturation.

Results The devices were successfully placed in all patients except three patients owing to the resistance of pulmonary hypertention. The systolic pulmonary pressure decreased from (97.3 ± 20.4) (range 70 to 140) mmHg to (51.2 ± 19.4) (33 to 109)mmHg, and the mean pulmonary pressure decreased from (71.2 ± 13.5) (51 to 105) mmHg to (36.4 ± 15.1)(22 to 71)mmHg. Complete angiographic closure was seen 10 minutes after the device deployment in 52 out of 82 patients (63.4%), while trivial to small leak was present in 30 (36.6%). During the occlusion, the average X-ray exposure duration was 16.9 +/- 10.3 minutes, occlusion time was 83.5 +/- 39.2 minutes. 15 of them with systolic pulmonary artery pressure > 70 mmHg after PDA closure were treated with sildenafil or/and bosentan. Complete echocardiographic closure was demonstrated in 77 out of 79 patients (97.5%) at 1 month, and 100% at 6-month follow-up in all patients. Among successful patients, the dimensions of the left atrium, left ventricle and pulmonary artery attenuated considerably in follow-up except for two patients. There were no PDA recanalization and migration of devices after the complete occlusion during following up.

Conclusions Transcatheter closure of patent ductus arteriosus with severe pulmonary hypertention using domestic occluder is a safe and effective interventional method in adults.

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