الفهرس 
Aim of the workOnly 14 pages are availabe for public view
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Abstract
Patent ductus arteriosus (PDA) is a persistent communication between the descending thoracic aorta and the pulmonary artery that results from failure of normal physiologic closure of the fetal ductus. PDA is one of the more common congenital heart defects; it has been estimated to occur in one in 2500–5000 live births. As an isolated lesion, it represents 9–12% of all congenital heart diseases (Castañeda, 2005).
This prospective observational study included 170 patients (in pediatric age) who had Patent ductus arteriosus and were suitable for percutaneous transcatheter closure (TCC). They were selected from National Heart institute during the period from July 2018 to February 2021. The procedure was performed in a cardiac catheterization unit at National Heart institute (NHI).
The aim of your study was evaluation of the frequency of different shapes of PDA among Egyptian children and proper choice of suitable device for each shape that is available in Egyptian market used for percutaneous trans-catheter closure (TCC). Trans-thoracic echocardiographic (TTE) follow up of acute and short-term outcome after PDA closure to assess safety and efficacy of closure.
Full clinical examination, echocardiography and laboratory evaluation were done before transcatheter closure at our catheterization laboratory showed that our patients were asymptomatic, symptomatic with hemodynamically dilated left side of the heart and symptomatic with severe pulmonary hypertension.
The procedure was done to all our patients successfully using Salidnger’s technique puncture; for both femoral vein and artery or only femoral vein (antegrade approach) in some patients and for femoral artery only (retrograde approach). Nine different devices were used to close PDA in our study; ADO-I, ADO-II, ADO-II AS, ODO, Nit Occlud PFM Coil, AVP II, ASDO, Muscular VSDO, MF-VSDO.
The age of the studied cases ranged from 6 months to 216 months (18 years) with mean 44.74 ± 45 months. Their weights ranged from five to 60 Kg with mean 14.94 ± 8.88 kg. Their Body surface area ranged from 0.30 to 1.76 m2 with mean 0.63 ± 0.25 m2.
One hundred sixty-one patients (94.7%) had PDA as isolated congenital heart lesion. Four patients (2.3 %) had PDA as a part of congenital syndrome; two cases had Down syndrome, one case had congenital rubella syndrome (CRS) and one case had Holt-Oram syndrome (HOS). Five patients (2.9%) had other congenital cardiac lesions rather than PDA: two patients had residual PDA after surgical correction of their other congenital anomalies; sub-aortic membrane (SAM) and partial atrioventricular canal defect (PAVC). The other three patients had percutaneous transcatheter correction for the other anomalies with PDA as pulmonary valvular stenosis (PS), ventricular septal defect (VSD) and atrial septal defect (ASD).
Echocardiographic assessment before catheterization: showed hemodynamically significance of PDA. Evidence of left side enlargement due to overflow across the PDA in 122 patients (71.7%), more than normal ranges according to Body Surface Area (BSA). M-Mode echocardiographic follow up after PDA closure showed left ventricular dimensions significantly decreased and fractional shortening (FS) significantly increased after one week and three month (p<0.001)
92.3% of our patients (n=157/170) had type A (conical). 1.2 % of our patients (n=2/170) had type B (window) ductus. 1.2 % of our patients (n=2/170) had type C (Tubular) ductus. One patient (0.6%) had type D (Complex). Eight patients (4.7%) had type E (Elongated) ductus. ADO-I device was used in 136 patients, ADO-II device was used in 14 patients, ADO-II AS device was used in two patients, Nit Occlud PFM Coil was used in 13 patients . AVP II, ASDO, Muscular VSDO and MF-VSDO were used in four different patients.
Thirty- Eight patients (22.3%) had severe reversible pulmonary hypertension with moderate to large PDA, after angiographic assessment, all patients were operable and successfully closed by suitable devices.