ASSA13-17-6 The Usefullness of Echocardiogram in Predicting Post-Procedural Pulmonary Artery Pressure in Patients with Patent Ductus Arteriosus and Severe Pulmonary Arterial Hypertension

Background Patent ductus arteriosus (PDA) is one of the commonest congenital heart defects which are prone to be complicated with pulmonary arterial hypertension (PAH). Objective The present study aims to assess the usefullness of echocardiogram in predicting post-procedural pulmonary artery pressure after transcatheter closure of PDA with severe PAH. Methods A cohort of patients with PDA and severe PAH undergoing transcatheter closure of PDA were included in this study. Patients with isolated PDA, cardiac function ≤NYHA class II, systolic pulmonary arterial pressure (sPAP) ≥70mmHg and pulmonary capillary wedge pressure ≤15mmHg and those who underwent cardiac catheterization under local anaesthesia were included in this study. After PDA was completely closed, pulmonary arterial pressure and aortic pressure were re-measured. According to post-closure sPAP, patients were divided into three groups: patients with sPAP<40mmHg (group A), from 40 to 70mmHg (group B) and > 70 mmHg (group C) after PDA closure. Differences in baseline parameters of echocardiogram and the correlations between these parameters and the decrease (%) in mean PAP were analysed. Results A total of 63 patients (49 females) aged from 10 to 60 years were recruited into this study. There was no significant differences in the age (P > 0.05) and the size of PDA (P > 0.05) between groups. The left atrium diameter indexes (35.96 ± 6.60 vs 31.17 ± 6.85 vs 22.24 ± 3.47 mm/m²; P < 0.05) and the left ventricular end diastolic volume indexes (279.45 ± 89.42 vs 162.88 ± 54.13 vs 60.94 ± 9.87 ml/m²; P < 0.05) decreased significantly from group A to group C. The left ventricular diameter/right ventricular diameter ratio in group C (1.86 ± 0.38) was less than that in group A (4.29 ± 1.85; P < 0.05) and group B (3.18 ± 1.21; P < 0.05) but had no significant difference between group A and group B. Linear regression analysis showed a significant correlation between the decrease in pulmonary artery mean pressure and the baseline of left ventricular end diastolic volume index (P < 0.05). Conclusions In patients with PDA and severe PAH, the baseline echocardiographic parameters are capable of predicting the outcome of transcatheter PDA closure. The decrease in pulmonary artery mean pressure after device closure is well correlated with the baseline left ventricular end diastolic volume index.