This protocol applies to patients with patent ductus arteriosus who have developed pulmonary arterial hypertension with pulmonary vascular resistance in the 3–5 Wood unit range and a haemodynamically significant left-to-right shunt (pulmonary to systemic flow ratio Qp:Qs >1.5).
In this sub-population, pulmonary arterial hypertension coexists with a persistent and significant shunt. With pulmonary vascular resistance elevated but not severely restrictive, and a Qp:Qs ratio exceeding 1.5, the ongoing left-to-right shunt remains a key haemodynamic factor that shapes management decisions.
When the left-to-right shunt remains significant, closure of the ductus is considered. The choice of closure method is guided by patient anatomy and duct characteristics — the full structured regimen details which approach is preferred and under what anatomical circumstances an alternative route applies.
DOI: 10.1093/eurheartj/ehaa554
In patients who have developed PAH with PVR 3–5 WU, PDA closure should be considered when there is still significant left-to-right shunt (Qp:Qs >1.5).
Device closure is recommended as the method of choice when technically suitable.
Surgery is reserved for the rare patient with a duct too large for device closure or with unsuitable anatomy such as aneurysm formation.
View source ↗