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High haemoglobin levels at the time of occlusion predict worse outcome for patients with patent ductus arteriosus and pulmonary hypertension

Published online by Cambridge University Press:  11 August 2022

Kanta Kishi ,
Jirayut Jarutach ,
Yinn Khurn Ooi ,
Ngie Liong Wong ,
Marhisham Che Mood ,
Geetha Kandhavello ,
Mazeni Alwi  and
Ming Chern Leong Open the ORCID record for Ming Chern Leong [Opens in a new window]
Kanta Kishi
Affiliation:
Division of Cardiology, Department of Paediatrics, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
Jirayut Jarutach
Affiliation:
Division of Cardiology, Department of Paediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
Yinn Khurn Ooi
Affiliation:
Paediatric Department, Cardiology Unit, Serdang Hospital, 43000 Serdang, Selangor, Malaysia
Ngie Liong Wong
Affiliation:
Department of Cardiology, Sarawak General Hospital, Jalan Tun Ahmad Zaidi Adruce, Kuching 93596, Sarawak, Malaysia
Marhisham Che Mood
Affiliation:
Paediatric & Congenital Heart Centre, Institut Jantung Negara (National Heart Institute), 145, Jalan Tun Razak, 50400 Kuala Lumpur, Malaysia
Geetha Kandhavello
Affiliation:
Paediatric & Congenital Heart Centre, Institut Jantung Negara (National Heart Institute), 145, Jalan Tun Razak, 50400 Kuala Lumpur, Malaysia
Mazeni Alwi
Affiliation:
Paediatric & Congenital Heart Centre, Institut Jantung Negara (National Heart Institute), 145, Jalan Tun Razak, 50400 Kuala Lumpur, Malaysia
Ming Chern Leong*
Affiliation:
Paediatric & Congenital Heart Centre, Institut Jantung Negara (National Heart Institute), 145, Jalan Tun Razak, 50400 Kuala Lumpur, Malaysia
*
Author for correspondence: Dr Ming Chern Leong, Paediatric & Congenital Heart Centre, Institut Jantung Negara, 145, Jalan Tun Razak, 50400 Kuala Lumpur, Malaysia. Tel: +603 2617 8470; Fax: +603 2694 6478. E-mail: mcleong@ijn.com.my
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Abstract

Introduction:

Current guidelines discourage shunt closure in patients with pulmonary vascular resistance index >8 Wood units x m2. The study examined the long-term outcome of patients over 15 years old, with pulmonary vascular resistance index >8 Wood units x m2 and patent ductus arteriosus.

Materials and methods:

This was a multi-institutional, retrospective study involving all consecutive patients (>15 years old) with patent ductus arteriosus and severe pulmonary hypertension. Patients who had patent ductus arteriosus closure were divided into the Good (no death or hospital admissions due to worsening pulmonary hypertension) and the Poor Outcome groups and these groups were compared.

Results:

Thirty-seven patients [male: 9 (24.3%); mean age: 30.49 ± 9.56 years; median follow-up: 3 (IQR: 1.5,10) years] were included from four centers. Twenty-two patients who underwent patent ductus arteriosus closure, 15 (71.4%) had good outcomes while 7 (28.6%) had poor outcomes. Pulmonary vascular resistance index and pulmonary to systemic resistance ratio (Rp:Rs) were lower in the Good Outcome Group (14.35 ± 1.66 Wood units x m2 vs. 20.07 ± 2.44; p = 0.033 and 0.44 ± 0.16 vs. 1.08 ± 1.21; p = 0.042). Haemoglobin concentrations (<14.3 g/dL) were associated with good long-term outcomes in the Closed Group.

Conclusions:

Patients with patent ductus arteriosus with severe pulmonary hypertension have a dismal outcome with or without closure. High haemoglobin levels at the time of occlusion predict a worse outcome for patients with patent ductus arteriosus and pulmonary hypertension.

Keywords

Patent ductus arteriosuspulmonary hypertensionlong-term outcome
Type
Original Article
Information
Cardiology in the Young , Volume 33 , Issue 8 , August 2023 , pp. 1359 - 1366
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Copyright
© The Author(s), 2022. Published by Cambridge University Press

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References

Schneider, DJ, Moore, JW. Patent ductus arteriosus. Circulation. 2006; 114: 1873–1882.CrossRefGoogle ScholarPubMed
Yamaki, S. Pulmonary vascular disease associated with pulmonary hypertension in 445 patients: diagnosis from lung biopsy and autopsy. Gen Thorac Cardiovasc Surg. 2013; 61: 24–31.CrossRefGoogle ScholarPubMed
D'Alto, M, Mahadevan, VS. Pulmonary arterial hypertension associated with congenital heart disease. Eur Respir Rev. 2012; 21: 328–337.CrossRefGoogle ScholarPubMed
Baumgartner, H, De Backer, J, Babu-Narayan, SV, et al. ESC Guidelines for the management of adult congenital heart disease. Eur Heart J. 2020; 42: 563–645.CrossRefGoogle Scholar
Lopes, AA, Barst, RJ, Haworth, SG, et al. Repair of congenital heart disease with associated pulmonary hypertension in children: what are the minimal investigative procedures? Consensus statement from the Congenital Heart Disease and Pediatric Task Forces, Pulmonary Vascular Research Institute (PVRI) [published correction appears in Pulm Circ. 2014 Sep;4(3):531]. Pulm Circ 2014; 4: 531–341.CrossRefGoogle Scholar
Hansmann, G, Koestenberger, M, Alastalo, TP, et al. 2019 updated consensus statement on the diagnosis and treatment of pediatric pulmonary hypertension: The European Pediatric Pulmonary Vascular Disease Network (EPPVDN), endorsed by AEPC, ESPR and ISHLT. J Heart Lung Transplant. 2019; 38: 879–901.CrossRefGoogle ScholarPubMed
Hansmann, G. Pulmonary hypertension in infants, children, and young adults. J Am Coll Cardiol. 2017; 69: 2551–2569.CrossRefGoogle ScholarPubMed
Rosenzweig, EB, Abman, SH, Adatia, I, et al. Paediatric pulmonary arterial hypertension: updates on definition, classification, diagnostics and management. Eur Respir J 2019; 53: 1801916.CrossRefGoogle ScholarPubMed
Jarutach, J, Roymanee, S, Wongwaitaweewong, K. Survival of patients after left-to-right shunt repaired of congenital heart defect: a comparison between baseline pulmonary vascular resistances. J. Health. Sci. Med. Res 2021; 39: 13–21.Google Scholar
Zhang, DZ, Zhu, XY, Lv, B, et al. Trial occlusion to assess the risk of persistent pulmonary arterial hypertension after closure of a large patent ductus arteriosus in adolescents and adults with elevated pulmonary artery pressure [published correction appears in Circ Cardiovasc Interv. 2014 Oct;7(5):731]. Circ Cardiovasc Interv 2014; 7: 731–481.CrossRefGoogle Scholar
Zabal, C, García-Montes, JA, Buendía-Hernández, A, et al. Percutaneous closure of hypertensive ductus arteriosus. Heart. 2010; 96: 625–629.CrossRefGoogle ScholarPubMed
Engelfriet, PM, Duffels, MG, Möller, T, et al. Pulmonary arterial hypertension in adults born with a heart septal defect: the Euro Heart Survey on adult congenital heart disease. Heart. 2007; 93: 682–687.CrossRefGoogle ScholarPubMed
Sadiq, M, Rehman, AU, Hyder, N, Qureshi, AU, Kazmi, T, Qureshi, SA. Intermediate- and long-term follow-up of device closure of patent arterial duct with severe pulmonary hypertension: factors predicting outcome. Cardiol Young 2017; 27: 26–36.CrossRefGoogle ScholarPubMed
Xu, J, Wang, L, Shen, Y, Geng, L, Chen, F. Transcatheter closure for patent ductus arteriosus in patients with Eisenmenger syndrome: to do or not? BMC Cardiovasc Disord 2020; 20: 505.CrossRefGoogle ScholarPubMed
Haworth, SG, Hislop, AA. Treatment and survival in children with pulmonary arterial hypertension: the UK Pulmonary Hypertension Service for Children 2001-2006. Heart. 2009; 95: 312–317.CrossRefGoogle ScholarPubMed
Manes, A, Palazzini, M, Leci, E, Bacchi Reggiani, ML, Branzi, A, Galiè, N. Current era survival of patients with pulmonary arterial hypertension associated with congenital heart disease: a comparison between clinical subgroups. Eur Heart J. 2014; 35: 716–724.CrossRefGoogle ScholarPubMed
Moustafa, GA, Kolokythas, A, Charitakis, K, Avgerinos, DV. Diagnostic cardiac catheterization in the pediatric population. Curr Cardiol Rev. 2016; 12: 155–162.CrossRefGoogle ScholarPubMed
Lundell, BP, Casas, ML, Wallgren, CG. Oxygen consumption in infants and children during heart catheterization. Pediatr Cardiol. 1996; 17: 207–213.CrossRefGoogle ScholarPubMed
Yamaki, S, Mohri, H, Haneda, K, Endo, M, Akimoto, H. Indications for surgery based on lung biopsy in cases of ventricular septal defect and/or patent ductus arteriosus with severe pulmonary hypertension. Chest. 1989; 96: 31–39.CrossRefGoogle ScholarPubMed
Siegel, FP, Petrides, PE. Congenital and acquired polycythemias. Dtsch Arztebl Int. 2008; 105: 62–68.Google ScholarPubMed
Ou, LC, Salceda, S, Schuster, SJ, et al. Polycythemic responses to hypoxia: molecular and genetic mechanisms of chronic mountain sickness. J Appl Physiol 1985. 1998; 84: 1242–1251.CrossRefGoogle ScholarPubMed
Caicedo, L, Hopper, RK, Garcia, H, et al. EXPRESS: Acute Vasoreactivity Testing in Pediatric Idiopathic Pulmonary Arterial Hypertension: an international Survey on Current Practice [published online ahead of print, 2019 May 30]. Pulm Circ 2019; 9: 2045894019857533.Google ScholarPubMed