Original paper
Transcatheter closure of patent ductus arteriosus among native high-altitude habitants

Aim: We present our experience in transcatheter closure of patent ductus arteriosus (PDA) performed during teaching courses in the highest capital in the world – La Paz (Bolivia). Methods: Ten consecutive patients (pts) with PDA were included in the study. Their age was 14 (1.1–50) years (y). In 9 pts type A, in 1 type E of PDA were found. Mean pulmonary artery pressure (MPAP) was 34 (7–80) mmHg and minimal diameter of PDA was 4.9 (1.5–8.5). One patient – a 4.3-year-old girl – had additionally valvular aortic stenosis (AS). Results: In 9 pts interventional catheterization with Amplatzer Duct Occluder (ADO) was performed in one with detachable coil. In one child 12/10 ADO went through 6 mm PDA and the procedure was abandoned. In 2 patients with wide PDA severe pulmonary hypertension (PH) was diagnosed. In both balloon occlusion test (BOT) of PDA showed 50% reduction of pulmonary pressure. No residual shunt after 24 hours was observed in any case after successful interventional catheterization. Conclusions: Patent ductus arteriosus in native habitants of high altitude have different physiopathology (higher pulmonary pressure) and anatomy (more frequent presence of wide PDAs). In the analysed cases pulmonary hypertension was reversible. The Amplatzer Duct Occluder seems to be the ideal device for transcatheter therapy for most of such patients. It is necessary to develop more interventional cardiology in the countries having such conditions as predominantly cardiosurgery methods exist there.