Patent ductus arteriosus at low and high altitudes: anatomical and haemodynamic features and their implications for transcatheter closure.

BACKGROUND

Living at high altitude increases the prevalence of patent ductus arteriosus (PDA) and may affect its morphology.

AIM

To compare the anatomical and haemodynamic features of isolated PDA in patients living at low and high altitudes (1,500-4,200 metres above sea level - m.a.s.l.).

METHODS

We studied retrospectively data from 1,404 consecutive patients - 708 living in lowland areas (group L) and 696 in highland areas (group H), in whom transcatheter closure of PDA was attempted. The mean age of the patients in group L was 9.9 ± 13.5 years and in group H it was 8.2 ± 19.7 years.

RESULTS

The diameter of PDA in group L was 2.3 ± 1.3 mm and 4.1 ± 1.2 mm in group H (p < 0.001), while the mean pulmonary artery pressure was 17.9 ± 5.9 mm Hg and 25.5 ± 12.3 mm Hg, respectively (p < 0.001). Angiographic PDA type A was more frequently observed in highland patients. In groups L and H, self expanding nitinol occluders (mostly Amplatzer devices) were used in 25.7% vs 92.2% of patients (p < 0.001), whereas coils were used in 69.2% vs 7.5% (p < 0.001), respectively. Double umbrella systems were used in 4.8% of patients in group L.

CONCLUSIONS

In catheterised patients with PDA living at high altitude, larger ductal diameter, anatomic type A and higher pulmonary artery pressure were more frequently observed. This finding has important implications for future strategy regarding transcatheter closure in populations living at different altitudes. Kardiol Pol 2011; 69, 5: 431-436.