title: Intermediate- and long-term follow-up of device closure of patent arterial duct with severe pulmonary hypertension: factors predicting outcome.
abstract: BACKGROUND
  In patients with large patent arterial ducts and severe pulmonary hypertension, the natural history of progression of pulmonary hypertension is very variable. Whether to close or not to close is often a difficult decision, as there are no established haemodynamic parameters predicting reversibility.
  
  
  OBJECTIVE
  The objectives of this study were to evaluate the results of device closure of large patent arterial ducts with severe pulmonary hypertension after 2 years of age and to determine haemodynamic variables associated with its regression during long-term follow-up.
  
  
  METHODS
  A total of 45 patients, with median age of 10 (2-27) years, with large patent arterial ducts and severe pulmonary hypertension, were considered. Haemodynamic variables were assessed in air, oxygen, and after occlusion. The follow-up was performed to assess regression of pulmonary hypertension.
  
  
  RESULTS
  Device closure was successful in 43 (96%) patients. Pulmonary artery systolic and mean pressures decreased from 79 to 67 mmHg and from 59 to 50 mmHg, respectively (p25% (both in oxygen) (p=0.007).
  
  
  CONCLUSIONS
  Device closure of large patent arterial ducts with severe pulmonary hypertension is safe and effective. Pulmonary vascular resistance index and systolic and mean pulmonary artery pressures in oxygen are the key prognostic variables predicting regression of pulmonary hypertension.
authors.affiliation: 1The Children's Hospital,Punjab Institute of Cardiology,Lahore,Pakistan.
authors.forename: Masood
authors.initials: M
authors.lastname: Sadiq
authors.affiliation: 1The Children's Hospital,Punjab Institute of Cardiology,Lahore,Pakistan.
authors.forename: Asif U
authors.initials: AU
authors.lastname: Rehman
authors.affiliation: 1The Children's Hospital,Punjab Institute of Cardiology,Lahore,Pakistan.
authors.forename: Najam
authors.initials: N
authors.lastname: Hyder
authors.affiliation: 1The Children's Hospital,Punjab Institute of Cardiology,Lahore,Pakistan.
authors.forename: Ahmad U
authors.initials: AU
authors.lastname: Qureshi
authors.affiliation: 1The Children's Hospital,Punjab Institute of Cardiology,Lahore,Pakistan.
authors.forename: Tehmina
authors.initials: T
authors.lastname: Kazmi
authors.affiliation: 2Evelina London Children's Hospital,Guy's and St Thomas' Trust,London,United Kingdom.
authors.forename: Shakeel A
authors.initials: SA
authors.lastname: Qureshi
mesh_terms: D000293:Adolescent; D000328:Adult; D001027:Aortography; D001794:Blood Pressure / Q000502:physiology*; D006328:Cardiac Catheterization / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D004374:Ductus Arteriosus, Patent / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D055989:Septal Occluder Device; D012720:Severity of Illness Index; D013997:Time Factors; D055815:Young Adult
keywords: CHD; cardiac catheterisation; device occlusion; patent arterial duct; pulmonary arterial hypertension