The study on the application of pulmonary systemic blood volume ratio in transcatheter closure of patent ductus arteriosus patients with severe pulmonary hypertension

Abstract:

Objective To compare and analyze the hemodynamics and cardiac ultrasound indexes before and after operation in patients with patent ductus arteriosus（PDA） complicated with severe pulmonary artery hypertension（PAH） who have undergone interventional treatment，so as to explore the correlation of pulmonary to systemic flow ratio（Qp/Qs） with pulmonary artery pressure change and cardiac structure recovery and predictive value of Qp/Qs after interventional treatment of such patients.Methods A total of 33 PDA patients complicated with PAH who had undergone interventional occlusion were divided into group A（Qp/Qs≥2.5） and group B（Qp/Qs<2.5） according to the preoperative Qp/Qs. The hemodynamic parameters obtained by cardiac catheterization before and after the operation were collected， and the results of transthoracic echocardiography（TTE） before and after the operation were recorded. The two groups were compared and analyzed.Results ①There was no difference in systolic pressure of pulmonary artery（sPAP） and mean pressure of pulmonary artery（mPAP） between the two groups before operation. Immediately after operation，the sPAP and mPAP in group A were lower than those in group B. ②The left ventricular end diastolic diameter index（LVEDDI），left atrial diameter index（LAI） and pulmonary artery diameter index（PAI） in group A were lower than those before operation at 48 hours，1 month and 3 months after operation，while only PAI and LVEDDI in group B were lower than those before operation at 3 months after operation. There was no difference in right ventricular end diastolic diameter index（RVEDDI） between the two groups before operation， and group A was lower than group B 3 months after operation. ③Five patients with immediate residual severe PAH occurred in group B. Among them，targeted drug therapy was significantly effective in 1 patient.Conclusion ①For PDA patients with severe PAH，the greater the Qp/Qs ratio，the more obvious the recovery of pulmonary artery pressure and cardiac structure after operation. ②Qp/Qs has a certain predictive value for the immediate residual severe PAH in these patients.