Patent ductus artieriosus (PDA) in lowland and highland patients

  • Jacek Bialkowski, Silesian Center for Heart Diseaes, Zabrze, Poland
  • Carlos Zabal, Instituto Nacional de Cardiologia, Mexico City, Mexico
  • Ramon Bermudez-Canete, Hospital Ramon y Cajal, Madrid, Spain
  • Ramon Flores, Hospital CNM 20 de Noviembre ISSSTE, Mexico City, Mexico
  • Hernan Diaz, Hospital UNICAR, Guatemala City, Guatemala
  • Ramiro Menacho, Hospital Obrero CNS, La Paz, Bolivia
  • Jaqueline Kreutzer, Children Hospital, Pittsbourgh, United States

    • Objective
    To compare the physiopatomorphology of PDAs in 1367 patients (pts) living in lowland (at altitude 0-700m) Group L and highland 1500-4200m - Group H.
    Method
    The hemodynamic data of 670 pts from Group H(age 9,5+/-12,8 y) and 697 from Group H (age 8,2+/-19,7 y) were analyzed. No preliminary selection of the pts with PDA were made.

    Results
    The diameter of the PDA was smaller and the mean pulmonary artery pressure was lower in Group L compared to Group H: 2,3 +/-1,2 vs 4,1+/-1,2 mm(p<0,001) and 17,9 +/-5,9 vs 25,5 +/- 12,3 mm Hg(p<0,001). PDA types (according Kirchenko) seen in Group L and Group H were respectively present as follows: type A 57,2% vs 81,2% (p<0,001,type B 4,5% vs 2,9%,type C 4,9% vs 2,6%, type D 7,9% vs 3,2% (p<0,001) and type E 25,5% vs 10,2%(p<0,001). According to morphology of PDA 68,1% of pts in Group L were treated with coils, 25,1% with Amplatzer Duct Occluders (ADO), 5,5% with Rashkind or Starflex umbrellas. In Group H 92,5. % pts were treated with ADO and 7,5% received coils. In both Groups in two pts Amplatzer Muscular VSD Occluder was implanted.
    Conclusions.
    PDAs in patients living at high altitude have a different anatomical and hemodynamic features compared to those living at lowland. This finding has important implication for further strategy of trans-catheter closure at different sites.