title: Patent ductus arteriosus at low and high altitudes: anatomical and haemodynamic features and their implications for transcatheter closure.
abstract: BACKGROUND
  Living at high altitude increases the prevalence of patent ductus arteriosus (PDA) and may affect its morphology.
  
  
  OBJECTIVE
  To compare the anatomical and haemodynamic features of isolated PDA in patients living at low and high altitudes (1,500-4,200 metres above sea level - m.a.s.l.).
  
  
  METHODS
  We studied retrospectively data from 1,404 consecutive patients - 708 living in lowland areas (group L) and 696 in highland areas (group H), in whom transcatheter closure of PDA was attempted. The mean age of the patients in group L was 9.9 ± 13.5 years and in group H it was 8.2 ± 19.7 years.
  
  
  RESULTS
  The diameter of PDA in group L was 2.3 ± 1.3 mm and 4.1 ± 1.2 mm in group H (p < 0.001), while the mean pulmonary artery pressure was 17.9 ± 5.9 mm Hg and 25.5 ± 12.3 mm Hg, respectively (p < 0.001). Angiographic PDA type A was more frequently observed in highland patients. In groups L and H, self expanding nitinol occluders (mostly Amplatzer devices) were used in 25.7% vs 92.2% of patients (p < 0.001), whereas coils were used in 69.2% vs 7.5% (p < 0.001), respectively. Double umbrella systems were used in 4.8% of patients in group L.
  
  
  CONCLUSIONS
  In catheterised patients with PDA living at high altitude, larger ductal diameter, anatomic type A and higher pulmonary artery pressure were more frequently observed. This finding has important implications for future strategy regarding transcatheter closure in populations living at different altitudes. Kardiol Pol 2011; 69, 5: 431-436.
authors: Silesian Centre for Heart Diseases, Congenital Heart Diseases and Paediatric Cardiology, Zabrze, Poland. jabi_med@poczta.onet.pl
authors: Jacek
authors: J
authors: Białkowski
authors: Jan
authors: J
authors: Głowacki
authors: Carlos
authors: C
authors: Zabal
authors: Antonio
authors: A
authors: Garcia-Montes
authors: Ramon
authors: R
authors: Bermudez-Canete
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authors: Flores-Arizmendi
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authors: Sagado-Sandova
authors: Hernan
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authors: Diaz de Leon
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authors: Kreutzer