The effects of ductal size on the severity of pulmonary hypertension in children with patent ductus arteriosus (PDA): a multi-center study

Abstract Introduction Patent ductus arteriosus (PDA) is a common acyanotic heart disease that presents with variable symptoms. Objectives This study is therefore aimed at determining the relationship between gender, age, and size of PDA and pulmonary hypertension. This study also seeks to determine the prevalence of elevated pulmonary artery systolic pressure in children with PDA. Patients and methods A descriptive study of children with patent ductus arteriosus was carried out from 2016 to 2020 in three institutions. The data were analysed with the IBM SPSS statistics for windows, version 20 (IBM Corp, Chicago) Result The mean ductal size was 3.78 (2.39) mm, with a minimum of 1.0 mm and a maximum size of 10.0 mm. The mean ductal size for males, 4.02 (2.53) mm was comparable with that of the females, 3.61 (2.28) mm (Student T-test = 0.8, 0.4). The mean pulmonary artery systolic pressure (PASP) of the patients was 43.36 (24.46) mmHg. Also the mean PASP was comparable among the males and the females, 48.37 (26.69) mmHg versus 39.63 (22.16) mmHg (Student T-test = 1.81, p = 0.07). There was no correlation between age and PASP (correlation coefficient = 0.009, p = 0.92). Sixty point two percent (60.2%) (62/103) of children with PDA had pulmonary hypertension. The proportion of males with pulmonary hypertension, 48.39% (30/62) was comparable with that of the females, 51.61% (32/62) (Chi2 = 2.05, p = 0.15) and females are 1.8 times more likely to have pulmonary hypertension as males (odds ratio 1.81, 95% CI 0.8–4.1). There was a positive correlation between ductal size and PASP (Pearson correlation coefficient = 0.26, p value = 0.007). Those with moderate and large sized duct tend to have moderate and severe pulmonary hypertension respectively and this is statistically significant. Chi2 = 17.85, p = 0.007 Conclusion The prevalence of pulmonary hypertension in children with PDA is 60.2%. Moderate and large size duct presents with moderate and severe pulmonary hypertension respectively. Females are 1.8 times more likely to have pulmonary hypertension than the males.

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MANAGEMENT OF HYPERTENSIVE PDA

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v70isuppl-4.6003 ◽

2021 ◽

Vol 70 (Suppl-4) ◽

pp. S701-05

Author(s):

Khushal Khan Khattak ◽

Maad Ullah ◽

Abdul Malik Sheikh ◽

Asma Kanwal ◽

Sajid Ali Shah ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Pulmonary Artery ◽

Patent Ductus Arteriosus ◽

Palliative Treatment ◽

Ductus Arteriosus ◽

Treatment Options ◽

Device Closure ◽

Surgical Ligation ◽

Percutaneous Catheter ◽

Patent Ductus

Objective: To determine different treatment options in patients of Patent Ductus Arteriosus with pulmonary hypertension beyond neonatal period. Study Design: Descriptive cross sectional study. Place and Duration of Study: This study was carried out in Pediatric Cardiology department of Rawalpindi Institute of Cardiology, from Jan 2017 to Jan 2019. Methodology: Patients having PDA with pulmonary hypertension were included in the study. Treatment options were divided into percutaneous catheter device closure, surgical ligation of patent ductus arteriosus and palliative treatment. Any adverse event during the procedure was documented. Stratification was done in regard to gender and age group. Post stratification chi square test was applied and p-value less than or equal to 0.05 was considered as significant. Results: Total number of patients included in the study were 37. Mean age (years) of patients (Mean ± SD) was 19.21 ± 8.76. Mean ± SD pulmonary artery pressure was 56.43 ± 11.55 mmHg. Percutaneous catheter device closure was successful in 24 (64.9%) patients, in 7 (18.9%) patients primary surgical PDA ligation was done, 3 (8.1%) patients were advised palliative treatment and in 3 (8.1%) patients adverse events occurred during percutaneous device closure and were thus referred for surgical ligation. Patent ductus Arteriosus Occlutech device was used in 18 (48.6%) patients, Occlutech VSD device was used in 7 (18.5%) patients and in 1 (2.7%) patient AGA duct occluder was used. Conclusion: In patients with patent ductus arteriosus and pulmonary artery hypertension, percutaneous catheter device closure is a safe and effective procedure.

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MODERATE TO SEVERE PULMONARY HYPERTENSION ACCOMPANYING PATENT DUCTUS ARTERIOSUS

Heart ◽

10.1136/hrt.26.5.600 ◽

1964 ◽

Vol 26 (5) ◽

pp. 600-605 ◽

Cited By ~ 12

Author(s):

J. M. Reid ◽

J. G. Stevenson ◽

E. N. Coleman ◽

R. S. Barclay ◽

T. M. Welsh ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Patent Ductus Arteriosus ◽

Ductus Arteriosus ◽

Severe Pulmonary Hypertension ◽

Patent Ductus

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Elevated Estimated Pulmonary Arterial Pressures in Patients with Chuvash Polycythemia.

Blood ◽

10.1182/blood.v104.11.1634.1634 ◽

2004 ◽

Vol 104 (11) ◽

pp. 1634-1634

Author(s):

Victor R. Gordeuk ◽

Adelina I. Sergueeva ◽

Galina Y. Miasnikova ◽

Lydia A. Polyakova ◽

Daniel J. Okhotin ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Pulmonary Artery ◽

Tricuspid Regurgitation ◽

Chronic Hypoxia ◽

Primary Pulmonary Hypertension ◽

Systolic Pressure ◽

Pulmonary Artery Systolic Pressure ◽

Normal Range ◽

Pulmonary Arterial ◽

The Mean

Abstract Chuvash polycythemia is characterized by a homozygous 598C>T mutation in VHL and up regulation of HIF-1α during normoxia. Disorders of chronic hypoxia may be complicated by the development of pulmonary hypertension. Because of the up regulation of the hypoxic response in Chuvash polycythemia, we postulated that there may be a tendency to increased pulmonary artery pressures in this condition as well. To test this hypothesis, we analyzed results for Doppler echocardiography in 15 patients with Chuvash polycythemia and 15 Chuvash individuals without polycythemia. The tricuspid regurgitation velocity (TRV) allows estimation of pulmonary artery systolic pressure. A TRV of 2.5 m/sec or higher corresponds to a pulmonary artery systolic pressure of at least 35 mm Hg (normal up to 32 mm Hg), while a TRV of 3.0 m/sec or higher to a pressure of at least 46 mm Hg. The results are summarized in the Table. Pulmonary artery pressures as estimated by tricuspid regurgitation velocity (TRV) in Chuvash subjects with and without polycythemia Chuvash polycythemia (n = 15) Controls (n = 15) P Age in years; mean (SD) 35 (17) 35 (17) 1.0 Female sex in no. (%) 8 (53%) 8 (53%) 1.0 Hemoglobin in g/dL; mean (SD) 16.7 (2.3) 13.3 (1.2) <0.001 TRV in m/sec; mean (SD) 2.2 (0.6) 1.4 (0.6) 0.001 TRV > 2.4 m/sec in no. (%) 4 (27%) 0 (0%) 0.1 Most of the patients with Chuvash polycythemia were receiving phlebotomy therapy and therefore many had hemoglobin concentrations in the upper normal range. Four of the patients with Chuvash polycythemia and none of the others had TRV ≥ 2.5 m/sec (range of 2.5 to 3.0), and mean TRVs were significantly higher in the patients with Chuvash polycythemia. Interestingly, the mean ± SD TRV in these 15 patients with Chuvash polycythemia was identical to the mean ± SD TRV that was recently reported in 195 American patients with sickle cell disease (Gladwin et al, NEJM2004;350:886), another hematological condition with a tendency to pulmonary hypertension. While the pulmonary arterial pressures detected so far in Chuvash polycythemia patients are lower than those in patients with primary pulmonary hypertension, our results suggest that pulmonary hypertension may be an unrecognized complication of Chuvash polycythemia.

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