Successful interventional closure of patent ductus arteriosus in three pediatric cases with congenital heart disease and severe pulmonary hypertension: a case series and literature review

TL;DR

This paper reports three successful cases of patent ductus arteriosus closure in children with severe pulmonary hypertension and congenital heart disease, showing improved outcomes with targeted therapy.

Contribution

The study demonstrates that interventional closure is feasible and beneficial for children with severe PH and CHD after targeted therapy.

Findings

All three patients showed successful PDA occlusion after targeted therapy.

Postoperative pulmonary artery pressure did not significantly increase.

Exercise tolerance improved in all patients during follow-up.

Abstract

To report three cases of successful closure of patent ductus arteriosus (PDA) with severe pulmonary hypertension (PH) and explore interventional closure strategies for congenital heart disease (CHD) complicated by severe PH. This study aims to determine whether such patients can undergo and benefit from interventional closure, providing clinical insights for physicians.

A retrospective analysis was conducted on three pediatric cases of PDA with severe PH successfully treated via interventional closure at the Department of Pediatric Cardiology, Guangdong Provincial People's Hospital. Literature related to “patent ductus arteriosus,” “severe pulmonary hypertension,” “Eisenmenger syndrome,” “targeted therapy,” and “interventional closure” (in both Chinese and English) was searched in PubMed and the China National Knowledge Infrastructure (CNKI) database up to November 2024. Case characteristics and therapeutic strategies were analyzed in conjunction with the literature.

All three pediatric patients had CHD combined with severe PH and underwent successful PDA occlusion after administration of at least 3 months of endothelin receptor antagonist or PDE5 inhibitor therapy (targeted therapy). Postoperative targeted therapy was continued, with follow-up until November 30, 2024. No significant elevation in pulmonary artery pressure (PAH) was observed, and exercise tolerance markedly improved in all cases.

Children with CHD and severe PH may qualify for interventional closure after a period of targeted therapy and could benefit from this procedure. Administering targeted medications before and after closure not only provides opportunities for intervention but also reduces the risk of persistent postoperative PAH.

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