Transcatheter closure for patent ductus arteriosus in patients with Eisenmenger syndrome: to do or not?

• Published in: BMC cardiovascular disorders 2020-12, Vol.20 (1), p.505-8, Article 505
• Main Authors: Xu, Jing, Wang, Liang, Shen, Yunli, Geng, Liang, Chen, Fadong
• Format: Article
• Language: English
• Subjects: Adult; Antihypertensive Agents - adverse effects; Antihypertensive Agents - therapeutic use; Arterial Pressure - drug effects; Blood pressure; Cardiac Catheterization - adverse effects; Care and treatment; Catheters; Combined Modality Therapy; Congenital diseases; Coronary vessels; Diagnostic treatment and repair strategy; Drug Therapy, Combination; Drugs; Ductus Arteriosus, Patent - diagnostic imaging; Ductus Arteriosus, Patent - physiopathology; Ductus Arteriosus, Patent - therapy; Eisenmenger Complex - diagnostic imaging; Eisenmenger Complex - physiopathology; Eisenmenger Complex - therapy; Eisenmenger syndrome; Female; Heart; Humans; Male; Morbidity; Occlusion; Oxygen saturation; Patent ductus arteriosus; Patient outcomes; Patients; Pulmonary arteries; Pulmonary artery; Pulmonary Artery - drug effects; Pulmonary Artery - physiopathology; Pulmonary hypertension; Recovery of Function; Retrospective Studies; Surgery; Targeted drugs; Time Factors; Transcatheter closure; Treatment Outcome; Vasodilator Agents - adverse effects; Vasodilator Agents - therapeutic use; Veins & arteries; Young Adult
• ISSN: 1471-2261; 1471-2261
• DOI: 10.1186/s12872-020-01795-5

Patent ductus arteriosus (PDA) complicated by Eisenmenger syndrome (ES) remains to be a major cause of morbidity and mortality worldwide. Giving increasing evidences of benefit from targeted therapies, ES patients once thought to be inoperable may have increasing options for management. This study aims to explore whether PDA in patients with ES can be treated with transcatheter closure (TCC). Between August 2014 and July 2016, four of fifteen PDA-ES patients whose Qp/Qs improved significantly and Qp/Qs > 1.5 after acute vasodilator testing with 100% oxygen were selected to receive TCC and pulmonary vasodilator therapy. PAH-targeted drugs were prescribed before and after occlusion for all. Trial occlusion was performed before permanent closure. The first TCC failed after initiation of PAH-targeted drugs for 6 months in four patients. After the medication was adjusted and extended to 12 months, TCC was performed for all without hemodynamic intolerances during perioperative period. Pulmonary artery systolic pressure (PASP) was significantly decreased (≥ 40%) immediately after TCC. During a mean follow-up of 48 ± 14.70 months, there were a further decrease of PASPs in two patients, the other two showed improved pulmonary vascular resistance, WHO functional class and six-minute walking distance despite deteriorated PASP. Some selected PDA-ES patients might benefit from TCC and combined PAH-targeted drugs play a crucial role.