Intravascular ultrasound evaluation of pulmonary hypertension in high-altitude patients with ventricular septal defect: a case report
Abstract
Background: High-altitude pulmonary hypertension is a rare but serious condition, particularly in individuals with congenital heart disease. Patent ductus arteriosus is a common congenital defect that may progress to irreversible pulmonary hypertension if untreated. However, operability assessment remains challenging in borderline cases. This case highlights the novel application of intravascular ultrasound to directly visualize pulmonary vascular remodeling in a patient with patent ductus arteriosus and high-altitude pulmonary hypertension, offering critical structural insight beyond conventional hemodynamic indices.
Case presentation: A 68-year-old Tibetan woman, a lifelong resident of the Garzê Tibetan Autonomous Prefecture in Sichuan, China (3500 m altitude), presented with a 2-year history of worsening dyspnea, leg swelling, and abdominal distension. Clinical evaluation revealed signs of right heart failure and a systolic heart murmur. Transthoracic echocardiography confirmed a large patent ductus arteriosus with bidirectional shunting and severe pulmonary hypertension. Chest computed tomography and angiography demonstrated dilated pulmonary arteries and pruning of distal branches. Right heart catheterization showed suprasystemic pulmonary artery pressure (130/55 mmHg), elevated pulmonary vascular resistance (15 Wood units), and a pathological pulmonary/systemic vascular resistance ratio of 0.92. Given the borderline operability, intravascular ultrasound was performed…
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Evidence Hub reads this as a case report, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
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