Insights in Pediatric Cardiology

Device Closure of Large Patent Ductus Arteriosus (PDA) in Young Infants: Analysis of Cases In a Bangladeshi Centre

Aim: To assess the efficacy, outcome, challenges, and complications faced in device closure of infants upto one year of age.

Methods: All infants from December 2014 to December 2019 were included in the study. Out of 440 cases of percutaneous closure of patent ductusarteriosus (PDA) performed in the study period in all age groups, 170 cases were infants up to one year of age. PDA were closed with Duct occluderCeraTM,,Amplatzer duct occluder II (ADOII), Konar - Multifunctional Occluder (MFO), AmplatzerMuscular device and Cook detachable coils. Demographics included age, weight,gender and gestational age. Procedure and device data included narrowest size of PDA, association with PDA, haemodynamic significance, device type and size used and outcome. This is a retrospective review of the outcome and complications from records of catheterization laboratory and Echocardiography laboratory of a tertiary level cardiac hospital of Bangladesh.

Results: Median age was 7 months (10 daysto 12 months),median weight was 4.5 kg (1.8– 8.6 kg), 62.94% were female and 37.06% were male, 81.18% of infants were born after 37 weeks of gestation and 18.82 % were born before 37 weeks of gestation. Narrowest PDA diameter varied from 1.8 mm to 8.2 mm with median 06 mm. Pulmonary artery pressure varied from 40/20 mmHg to 105/70 mm Hg with median 70/40 mm Hg. Down syndrome was associated with 12.94% cases and congenital rubella syndrome in 8.82% cases. Most used device was 8X6 duct occluder. One hundred sixty-nine (99.41%) cases had complete closure and only one case (0.59%) required surgical closure due to embolization.

Conclusion: Transcatheter closure of PDA is a very safe, effective option of PDA closure in infants using various types of case appropriate devices in the market. In this series infants presented with heart failure, severe pulmonary hypertension, even with suprasystemicpulmonary pressure were cured completely immediately after closure.

Keywords

Patentductusarteriosus, LargetubularPDA,Infants, Outcome.

Abbreviations

ADOII-Amplatzer duct occlude II, MFO- Multifunctional Occluder. PDA- Patent ductusarteriosus, PAH- Pulmonary arterial hypertension, ASD – Atrial septal defect, MVP- Mitral valve prolapse, PM VSD- Perimembranous ventricular septal defect, PS- Pulmonary stenosis, CoA- Coarctation of aorta.

Author(s):

Nurun Nahar Fatema

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