Successful Patent Ductus Arteriosus Closure in Patients With Severe Pulmonary Arterial Hypertension.

https://e-jcvi.org A 48-year-old female was referred to our department due to severe dyspnea for several years in conditions of non-ischemic heart failure and uncontrolled type 2 diabetes. Physical examination revealed rales in both lungs, regular heart sounds without murmurs, clubbing of the toes (Figure 1A), and no pitting edema. Chest X-ray showed cardiomegaly and prominent pulmonary vasculature (Figure 1B). Laboratory findings reported elevated brain natriuretic peptide. Transthoracic echocardiography demonstrated patent ductus arteriosus (PDA) with bidirectional shunting (Figure 2, Supplementary Table 1, Movie 1). Right cardiac catheterization revealed severe pulmonary arterial hypertension (PAH) with right ventricle dysfunction (mean pulmonary artery pressure [PAP]: 78 mmHg, pulmonary capillary wedge pressure: 12 mmHg, pulmonary vascular resistance [PVR]: 27.8 Wood units [WU], Qp/Qs: 1.18, and cardiac output: 4.1 L/min by Fick method). We diagnosed PAH associated with PDA1) and started treatment with oral sildenafil (20 mg) 3 times a day in addition to ambrisentan (5 mg) once a day. We conducted a 15-minute closure test on the PDA by measuring the pressure gradient between the central aorta and PA. A decrease of mean PAP by 15 mmHg was observed without any change in cardiac output (Figure 3, Supplementary Table 1). Finally, we performed PDA closure with an Amplatzer septal occluder (8/6 mm). The patient has been in a stable condition with advanced medical treatment for three years (Figure 4, Supplementary Table 1, Movie 2). Although current guidelines recommend PDA closure in patients with high PVR (>5 WU) and Qp/Qs >1.52)3) (class IIb), shunt closure may also be J Cardiovasc Imaging. 2023 Jul;31(3):152-154 https://doi.org/10.4250/jcvi.2022.0089 pISSN 2586-7210·eISSN 2586-7296