Preclosure Pressure Gradients Predict Patent Ductus Arteriosus Patients at Risk for Later Left Pulmonary Artery Stenosis |
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Authors: | Srinath T. Gowda Shelby Kutty Makram Ebeid Athar M. Qureshi Sarah Worley Larry A. Latson |
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Affiliation: | (1) Children’s Hospital of Michigan, Department of Pediatric Cardiology, Detroit Medical Center, Detroit, MI 48201, USA;(2) University of Nebraska/Creighton University Joint Division of Pediatric Cardiology, Children’s Hospital and Medical Center, Omaha, NE 68114, USA;(3) Department of Pediatric Cardiology, The University of Mississippi Medical Center, Jackson, MI 39216, USA;(4) Department of Pediatric Cardiology, The Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA;(5) Department of Quantitative Health Sciences, The Cleveland Clinic, Cleveland, OH 44195, USA |
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Abstract: | The objective of this study was to evaluate the incidence of pre-existing catheterization left pulmonary artery (LPA) gradients and correlation of these gradients with later LPA stenosis after successful patent ductus arteriosus (PDA) occlusion. We performed a single-center review of 130 patients with PDA closure from October 1993 to February 2005. We analyzed the pre-PDA closure LPA pressure gradients at catheterization to determine if these were predictive of late LPA stenosis. On follow-up, a V max >2 m/s by echocardiogram (transthoracic echocardiography; TTE) was considered indicative of possible LPA stenosis. Left lung perfusion of <35% was considered diagnostic of significant LPA stenosis. Post PDA closure, possible LPA stenosis by TTE was seen in 8 of 128 patients (6.25%). Seven of these eight had precatheter LPA gradients >7 mm Hg. Five of these had perfusion scans, three of the five had significant LPA stenosis, and two underwent LPA angioplasty. Patients with LPA catheter gradients >7 mm Hg were more likely to have possible LPA stenosis by TTE, significant LPA stenosis by lung scan, and intervention with LPA angioplasty. In conclusion, a preclosure main pulmonary artery-to-LPA pressure gradient >7 mm Hg was found in all patients who developed significant LPA stenosis on follow-up after transcatheter PDA closure. It appears likely that these patients have LPA abnormality rather than stenosis caused by the PDA occlusion device. Patients with preclosure LPA gradients >7 mm Hg should undergo follow-up evaluations for detection of significant stenosis and may require treatment if an important flow abnormality is documented. |
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