The effects of ductal size on the severity of pulmonary hypertension in children with patent ductus arteriosus (PDA): a multi-center study

Josephat M Chinawa,Awoere T Chinawa,Chika O Duru,Bartholomew F Chukwu

doi:10.1186/s12890-021-01449-y

Josephat M Chinawa, Awoere T Chinawa + Show 2 more

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https://doi.org/10.1186/s12890-021-01449-y

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Abstract

IntroductionPatent ductus arteriosus (PDA) is a common acyanotic heart disease that presents with variable symptoms.ObjectivesThis study is therefore aimed at determining the relationship between gender, age, and size of PDA and pulmonary hypertension. This study also seeks to determine the prevalence of elevated pulmonary artery systolic pressure in children with PDA.Patients and methodsA descriptive study of children with patent ductus arteriosus was carried out from 2016 to 2020 in three institutions. The data were analysed with the IBM SPSS statistics for windows, version 20 (IBM Corp, Chicago)ResultThe mean ductal size was 3.78 (2.39) mm, with a minimum of 1.0 mm and a maximum size of 10.0 mm. The mean ductal size for males, 4.02 (2.53) mm was comparable with that of the females, 3.61 (2.28) mm (Student T-test = 0.8, 0.4). The mean pulmonary artery systolic pressure (PASP) of the patients was 43.36 (24.46) mmHg. Also the mean PASP was comparable among the males and the females, 48.37 (26.69) mmHg versus 39.63 (22.16) mmHg (Student T-test = 1.81, p = 0.07). There was no correlation between age and PASP (correlation coefficient = 0.009, p = 0.92). Sixty point two percent (60.2%) (62/103) of children with PDA had pulmonary hypertension. The proportion of males with pulmonary hypertension, 48.39% (30/62) was comparable with that of the females, 51.61% (32/62) (Chi2 = 2.05, p = 0.15) and females are 1.8 times more likely to have pulmonary hypertension as males (odds ratio 1.81, 95% CI 0.8–4.1). There was a positive correlation between ductal size and PASP (Pearson correlation coefficient = 0.26, p value = 0.007). Those with moderate and large sized duct tend to have moderate and severe pulmonary hypertension respectively and this is statistically significant. Chi2 = 17.85, p = 0.007ConclusionThe prevalence of pulmonary hypertension in children with PDA is 60.2%. Moderate and large size duct presents with moderate and severe pulmonary hypertension respectively. Females are 1.8 times more likely to have pulmonary hypertension than the males.

Highlights

Patent ductus arteriosus (PDA) is a common acyanotic heart disease that presents with variable symptoms
This study seeks to determine the prevalence of elevated pulmonary artery systolic pressure in children with PDA
The relationship between ductal size and severity of pulmonary hypertension is shown in Table 3 which revealed that 42.86% of those with small ductal size had mild pulmonary hypertension and none had severe pulmonary hypertension while 44.44% of those with large ductal size had mild hypertension and 33.33% had severe pulmonary hypertension

Summary

Introduction

Patent ductus arteriosus (PDA) is a common acyanotic heart disease that presents with variable symptoms. The ductus arteriosus is a remnant of the distal sixth aortic arch. Patent ductus arteriosus (PDA) is usually a left aortic remnant [1]. The prevalence of PDA is variable ranging from [5 to 10%] [1, 2]. This lesion is the major cause of mortality and morbidity in infancy. The hemodynamic effects of PDA are well known including pulmonary hypertension, systemic hypo-perfusion, and volume overload on the left ventricle [4]

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