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SURGERY OF PDA WITH PAH, Closure of PDA in a child or young adult with, significantly elevated pulmonary vasculature, resistance is not simple., Catheterization is recommended in these patients, to evaluate the pulmonary vasculature bed’s, response to test occlusion with a balloon catheter, and pulmonary vasodilators such as oxygen and, Nitric oxide., If there is a good response, whereby a significant, decrease in pulmonary artery diastolic pressure and, decrease in calculated pulmonary vascular, resistance occurs, closure is advised., Device closure should be considered in this setting,, if the surgical risk is increased because of significant, pulmonary hypertension., However, if the response to test occlusion with, pulmonary vasodilators is equivocal, the decision is, more difficult.

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Aggressive treatment with pulmonary vasodilators, including home oxygen, sildenafil, bosentan and, inhaled iloprost should be considered with repeat, catheterization in 4 to 9 months with repeat, evaluation and consideration for devise closure., Some patients respond and show significant, improvement after PDA closure, whereas others, show a progressive increase in pulmonary, vasculature resistance after closure.., Therefore careful monitoring and use of pulmonary, vasodilators after closure is needed., The only Contraindications to closure of an isolated, PDA is severe pulmonary hypertension with, irreversible pulmonary vascular disease and, baseline right to left ductal shunting despite, maximal medical pulmonary vasodilation., If PDA is closed in these patients, they are incapable, of maintaining, an adequate systemic output in, response to stress, and rapid deterioration and, death frequently occurs.