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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.
Keywords
patent ductus arteriosus, Eisenmenger syndrome, transcatheter closure, diagnostic treatment and repair strategy, targeted drugs.
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CURRENT STATUS: Published
View the published article at BMC Cardiovascular Disorders.
No community comments so far
Submission checks complete
On 25 Nov, 2020
Editorial decision: Accept
On 23 Nov, 2020
Editor assigned
On 22 Nov, 2020
Editor invited
On 22 Nov, 2020
No comments provided
Editorial decision: Minor revision
On 16 Nov, 2020
Review #2 received
Received 15 Nov, 2020
Reviewer #2 agreed
On 14 Nov, 2020
Reviewer #1 agreed
On 14 Nov, 2020
Review #1 received
Received 14 Nov, 2020
Editor assigned
On 11 Nov, 2020
Reviewers invited
Invitations sent on 11 Nov, 2020
Submission checks complete
On 11 Nov, 2020
Editor invited
On 11 Nov, 2020
No comments provided
Review #2 received
Received 19 Oct, 2020
Editorial decision: Major revision
On 19 Oct, 2020
Reviewer #2 agreed
On 18 Oct, 2020
Review #1 received
Received 17 Oct, 2020
Reviewer #1 agreed
On 16 Oct, 2020
Reviewers invited
Invitations sent on 15 Oct, 2020
Editor assigned
On 04 Sep, 2020
Submission checks complete
On 03 Sep, 2020
Editor invited
On 03 Sep, 2020
Version 1
Posted 25 Jun, 2020
No comments provided
Editorial decision: Major revision
On 05 Aug, 2020
Reviewer #3 agreed
On 02 Aug, 2020
Review #1 received
Received 26 Jul, 2020
Review #2 received
Received 26 Jul, 2020
Reviewer #2 agreed
On 21 Jul, 2020
Reviewer #1 agreed
On 02 Jul, 2020
Reviewers invited
Invitations sent on 26 Jun, 2020
Editor assigned
On 21 Jun, 2020
Submission checks complete
On 20 Jun, 2020
Editor invited
On 20 Jun, 2020
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Subject Areas
Cardiac & Cardiovascular Systems
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A new preprint design is coming!
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See the published version of this preprint at BMC Cardiovascular Disorders.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Cardiovascular Disorders.
No community comments so far
Submission checks complete
On 25 Nov, 2020
Editorial decision: Accept
On 23 Nov, 2020
Editor assigned
On 22 Nov, 2020
Editor invited
On 22 Nov, 2020
No comments provided
Editorial decision: Minor revision
On 16 Nov, 2020
Review #2 received
Received 15 Nov, 2020
Reviewer #2 agreed
On 14 Nov, 2020
Reviewer #1 agreed
On 14 Nov, 2020
Review #1 received
Received 14 Nov, 2020
Editor assigned
On 11 Nov, 2020
Reviewers invited
Invitations sent on 11 Nov, 2020
Submission checks complete
On 11 Nov, 2020
Editor invited
On 11 Nov, 2020
No comments provided
Review #2 received
Received 19 Oct, 2020
Editorial decision: Major revision
On 19 Oct, 2020
Reviewer #2 agreed
On 18 Oct, 2020
Review #1 received
Received 17 Oct, 2020
Reviewer #1 agreed
On 16 Oct, 2020
Reviewers invited
Invitations sent on 15 Oct, 2020
Editor assigned
On 04 Sep, 2020
Submission checks complete
On 03 Sep, 2020
Editor invited
On 03 Sep, 2020
Version 1
Posted 25 Jun, 2020
No comments provided
Editorial decision: Major revision
On 05 Aug, 2020
Reviewer #3 agreed
On 02 Aug, 2020
Review #1 received
Received 26 Jul, 2020
Review #2 received
Received 26 Jul, 2020
Reviewer #2 agreed
On 21 Jul, 2020
Reviewer #1 agreed
On 02 Jul, 2020
Reviewers invited
Invitations sent on 26 Jun, 2020
Editor assigned
On 21 Jun, 2020
Submission checks complete
On 20 Jun, 2020
Editor invited
On 20 Jun, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Cardiac & Cardiovascular Systems
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Cardiovascular Disorders.
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.
Figure 1
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