title: 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.
abstract: BACKGROUND
  No method is available to predict whether patients with patent ductus arteriosus (PDA) and severe pulmonary arterial hypertension (PAH) will show persistent postprocedural PAH (PP-PAH) after PDA closure. This study evaluated the usefulness of trial occlusion for predicting PP-PAH after transcatheter PDA closure in patients with severe PAH.
  
  
  RESULTS
  Trial occlusion was performed in 137 patients (age ≥12 years) with PDA and severe PAH. All patients undergoing trial occlusion had a mean pulmonary artery pressure ≥45 mm Hg, pulmonary:systemic flow (Qp/Qs) ratio >1.5, and pulmonary:systemic resistance (Rp/Rs) ratio <0.7. A total of 135 patients (98%) showing stable hemodynamics during occlusion trial underwent successful device closure. Linear correlation analysis revealed weak or moderate relationships between the baseline and post-trial pulmonary artery pressures and pulmonary:systemic pressure (Pp/Ps) ratios. Patients were followed up for 1 to 10 years (median: 5 years). PP-PAH (systolic pulmonary artery pressure >50 mm Hg by Doppler echocardiography) was detected in 17 patients (13%), who displayed no significant differences in sex and age compared with patients without PP-PAH. According to discriminant analysis, the strongest discriminators between patients with and without PP-PAH were the baseline left ventricular end-diastolic volume and the baseline and post-trial systolic Pp/Ps ratios. In particular, a post-trial systolic Pp/Ps ratio >0.5 correctly classified 100% of the PP-PAH and non-PAH patients.
  
  
  CONCLUSIONS
  Trial occlusion is a feasible method to predict PP-PAH in patients with PDA and severe PAH. A post-trial systolic Pp/Ps ratio >0.5 indicates a high risk of PP-PAH occurrence after device closure.
authors.affiliation: From the Department of Congenital Heart Disease, General Hospital of Shenyang Military Area Command, Shenyang, People's Republic of China. zhdz11@163.com.
authors.forename: Duan-Zhen
authors.initials: DZ
authors.lastname: Zhang
authors.affiliation: From the Department of Congenital Heart Disease, General Hospital of Shenyang Military Area Command, Shenyang, People's Republic of China.
authors.forename: Xian-Yang
authors.initials: XY
authors.lastname: Zhu
authors.affiliation: From the Department of Congenital Heart Disease, General Hospital of Shenyang Military Area Command, Shenyang, People's Republic of China.
authors.forename: Bei
authors.initials: B
authors.lastname: Lv
authors.affiliation: From the Department of Congenital Heart Disease, General Hospital of Shenyang Military Area Command, Shenyang, People's Republic of China.
authors.forename: Chun-Sheng
authors.initials: CS
authors.lastname: Cui
authors.affiliation: From the Department of Congenital Heart Disease, General Hospital of Shenyang Military Area Command, Shenyang, People's Republic of China.
authors.forename: Xiu-Min
authors.initials: XM
authors.lastname: Han
authors.affiliation: From the Department of Congenital Heart Disease, General Hospital of Shenyang Military Area Command, Shenyang, People's Republic of China.
authors.forename: Xiao-Tang
authors.initials: XT
authors.lastname: Sheng
authors.affiliation: From the Department of Congenital Heart Disease, General Hospital of Shenyang Military Area Command, Shenyang, People's Republic of China.
authors.forename: Qi-Guang
authors.initials: QG
authors.lastname: Wang
authors.affiliation: From the Department of Congenital Heart Disease, General Hospital of Shenyang Military Area Command, Shenyang, People's Republic of China.
authors.forename: Po
authors.initials: P
authors.lastname: Zhang
mesh_terms: D000293:Adolescent; D000328:Adult; D004374:Ductus Arteriosus, Patent / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis* / Q000517:prevention & control; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011379:Prognosis; D011651:Pulmonary Artery / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D055989:Septal Occluder Device / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures; D055815:Young Adult
keywords: ductus arteriosus, patent; hypertension, pulmonary