CASE REPORT article
Front. Cardiovasc. Med.
Sec. General Cardiovascular Medicine
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1569963
Case report: Non-reactive vasoreactivity testing in a patient with patent ductus arteriosus with pulmonary hypertension: is there still a way to turn things around?
Provisionally accepted
- 1Department Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- 2Faculty of Medicine, University of Indonesia, Jakarta, Papua, Indonesia
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Background: Recent guidelines recommend patent ductus arteriosus (PDA) closure in adults based on hemodynamic criteria, such as pulmonary vascular resistance (PVR) and flow ratio (Qp:Qs). However, additional parameters like acute vasoreactivity testing (AVT) and closure testing, though lacking extensive data, may assist in identifying patients eligible for closure. We present the case of an adult patient with PDA and pulmonary hypertension (PH) whosuccessfully underwent transcatheter device closure guided by AVT and closure testing.Case presentation: A 35-year-old female presented with a two-year history of shortness of breath, cyanosis, and peripheral edema. She had been diagnosed with PDA at birth but did not undergo ligation due to parental refusal, leading to a 33-year loss of follow-up. Echocardiography revealed a bidirectional shunt through the PDA. Following cardiac catheterization (Qp:Qs 1.38, PVR 21.5 WU) with AVT, the patient was diagnosed with PDA, PH with low flow, high resistance, and non-reactive to vasoreactivity test. She was prescribed sildenafil and discharged. After one year, the patient reported symptom improvement, with repeat catheterization showing a slight reduction in Qp:Qs (1.25) and PVR (16.38 WU), though values remained above the guideline cut-off for closure. However, the patient was then reactive to AVT, so we decided to perform device closure and observed the patient for 10 minutes before releasing the device. The patient was stable following the procedure and recovered well. One month later, the patient experienced significant symptom relief and could engage in moderate physical activity without discomfort.This case highlights the potential AVT, closure testing, and also the treat-and-repair strategy with sildenafil to expand the window of operability in adult PDA patients with PH. Further research especially on long-term outcomes, is recommended.
Keywords: patent ductus arteriosus, pulmonary hypertension, Acute vasoreactivity testing, Closure test, sildenafil, Percutaneous closure
Received: 21 Feb 2025; Accepted: 17 Jul 2025.
Copyright: © 2025 Siagian, Panjaitan and Nugroho. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Elsa Hedia Panjaitan, Faculty of Medicine, University of Indonesia, Jakarta, 10430, Papua, Indonesia
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