Treatment of Patent Ductus Arteriosus in Pulmonary Arterial Hypertension with Elevated Pulmonary Vascular Resistance
When patent ductus arteriosus occurs alongside established pulmonary arterial hypertension and elevated pulmonary vascular resistance, the clinical picture is substantially more complex. Whether — and how — to close the duct depends on careful haemodynamic evaluation and expert judgement.
This protocol addresses patients with pulmonary arterial hypertension (PAH) who have a pulmonary vascular resistance (PVR) of ≥5 Wood units and a persisting significant left-to-right shunt, defined by a pulmonary-to-systemic flow ratio (Qp:Qs) of >1.5.
PDA closure may be considered in this setting when the left-to-right shunt remains significant — but the decision requires careful, individualised assessment at an expert centre. When technically feasible, a catheter-based approach is the preferred method; surgical intervention is reserved for specific anatomical circumstances.
The complete eligibility criteria, procedural pathway, and decision algorithm are detailed in the full protocol.
References
DOI: 10.1093/eurheartj/ehaa554
- In patients who have developed PAH with PVR ≥5 WU, PDA closure may be considered when there is still significant LR shunt (Qp:Qs >1.5) but careful individual decision in expert centres is required.
- 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.