Transcatheter closure for patent ductus arteriosus in patients with Eisenmenger syndrome: to do or not?

Abstract

Background Patent ductus arteriosus (PDA) complicated by Eisenmenger syndrome (ES) remains to be a major cause of morbidity and mortality worldwide. Giving increasing evidence of benefit from targeted drug therapies, ES patients once thought to be inoperable may have increasing options for management. This study aims to explore whether the PDA in patients with ES can be treated with transcatheter closure (TCC).Methods Between August 2014 and July 2016, four out of fifteen PDA-ES patients whose Qp/Qs improved significantly and Qp/Qs > 1.5 after acute vasodilator testing with 100% oxygen were selected to receive TCC by diagnostic treatment and repair strategy. PAH-targeted drugs were prescribed before and after occlusion for all patients. Trial occlusion was performed before permanent closure.Results The first TCC failed after the initiation of PAH-targeted drugs for 6 months in four patients. After the medication was adjusted and extended to 12 months, TCC was performed for all without hemodynamic intolerances during perioperative period. Pulmonary artery systolic pressure (PASP) was significantly decreased (≥ 40%) immediately after TCC. During the follow-up period, there was a further decrease of PASP in two patients, the other two showed improved WHO functional class and six-minute walking distance although a worsening PASP.Conclusion Some selected PDA-ES patients with PVR < 15Wood U and Qp/Qs > 1.5 at baseline might benefit from TCC by diagnostic treatment and repair strategy and uninterrupted combination of PAH-targeted drugs pre- and post-occlusion play a crucial role.