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CLINICAL OUTCOME AFTER LEFT-TO-RIGHT SHUNT CLOSURE IN PATIENTS WITH PULMONARY ARTERY HYPERTENSION DUE TO ATRIAL SEPTAL DEFECT, VENTRICULAR SEPTAL DEFECT AND PATENT DUCTUS ARTERIOSUS
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Abstract
Background: Intervention to close the left-right shunt by surgery or percutaneous procedure in patients with atrial septal defect, ventricular septal defect and patent ductus arteriosus in Vietnam as well as low- and middle-income countries is often common. performed when the disease has severe pulmonary arterial hypertension. Data on pulmonary hemodynamic parameters affecting clinical outcomes in these patients remain limited. Objective: To evaluate short-term and long-term clinical outcomes after left-right shunt closure intervention by procedure or surgery in patients with severe pulmonary arterial hypertension due to ASD, VSD and PDA. Methods: We performed a retrospective and prospective cohort study of all cases of ASD, VSD and PDA with severe pulmonary arterial hypertension undergoing cardiac catheterization to measure pulmonary vascular resistance before left-right shunt closure from April/ 2017 to April 2022 at the Heart Institute of Ho Chi Minh City. Kaplan-Meier curves, Cox regression with Firth correction were used for analysis. Results: A total of 110 consecutive patients (mean age 35.59 ± 15.47; 70.90% female) of which ASD accounted for 67.3% (74 patients), PDA 19.10% (21 patients), VSD 10% (11 patients) and combined shunt disease 3.6 % (4 patients). Surgical closure of the shunt accounts for 74.55% of cases. Early death (during hospital stay) accounted for 5.45% (6 patients). The cumulative survival rates of patients after 1 month, 1 year and 3 years were 94.5%, 91.8% and 89.1%, respectively. The average survival time of patients after shunt closure is 33.40 ± 0.87 months and 95% confidence interval: 31.69-35.11. Conclusion: Cumulative survival rate after shunt closure in patients with severe pulmonary hypertension due to atrial septal defect, ventricular septal defect and patent ductus arteriosus after 1 month, 1 year and 3 years is 94.5, respectively. %, 91.8% and 89.1%.
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Keywords
Pulmonary vascular resistance, cardiac catheterization, left-to-right shunt, pulmonary arterial pressure, pulmonary arterial hypertension.
References
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