Patent ductus arteriosus  at lowland and highland habitants: Implications for transcatheter closure – A retrospective multinational registry study.

    Jacek Bialkowski on behalf  of WG Interventional Cardiology Latin Pediatric Cardiology Society

    The purpose of this  study was to compare the  anatomical and hemodynamic features of  the patent ductus arteriosus (PDA) in patients (pts) living at low  (group L) and  high altitude (group H)  (1500-4200 meters above sea level).  In all  transcatheter closure of PDA using different devices was attempted. Data was collected retrospectively at multiple institutions in 1404  consecutive pts – 708 in group L and 696 in group H. Mean pts age s in group L  was 9， 9 +/- 13， 5 years  and    in group H  -  8，2+/-19，7 years. The diameter of the PDA was  2，3 +/-1，3 in group  L and 4，1+/-1，2 mm in group  H (p<0，001). The mean pulmonary artery pressure was  17，9 +/- 5，9  and  25，5 +/- 12，3 mm Hg  respectively (p<0，001). In the group H in comparison to the group L more frequently angiographic type A of  PDA was observed， in the group L in comparison to group H types B， C， D， E and R.  In   group L the procedure was successful in 99，4% and in group  H in   99，1%. Following devices were used in group L and H:  self expanding nitinol occluders (mostly Amplatzer devices) 25，7% vs 92，2% ( p<0，001)， coils 69，2% vs 7，5% ( p<0，001) respectively. In 4，8% of pts in group  L double umbrella systems were applied.

    In conclusion PDAs in pts living at  high altitude have a different anatomical and hemodynamic features compared to those  living at lowland. This finding has an important implication  for further strategy of transcatheter closure at different sites.

 Table 1
Catheterization data  obtained in patients with patent ductus arteriosus living at low and high altitude.

Legend

     Group L – patients with PDA  living permanentlyat low altitude， group H – patients with PDA  living permanently at high altitude， p – probablility of  statistical  significance， MPAP- mean pulmonary artery pressure， PDA diam – minimal ductal diameter， Type of PDA – types of PDA according to Kirchenko， a-v loop –needy to create arterio-venous loop， – Rashkind/ StarFLEX double umbrella systems * self-expanding nitinol wire-mesh occluders ( mostly Amplatzer devices) .