CATHETER BASED CLOSURE OF HYPERTENSIVE PDA(S) WITH UNCONVENTIONAL DEVICES –IMMEDIATE AND SHORT TERM FOLLOW UP

Abstract

Patent ductus arteriosus (PDA) is a common form of CHD, accounts for approximately 8% of congenital heart disease with the incidence of one in 2500 to 5000 live births. More common in female. It may be asymptomatic and is sometimes not diagnosed early resulting into prolonged abnormal aorto-pulmonary shunt which may result in silently progressing hypertension and left ventricular dysfunction. This study aims to evaluate the immediate &short-term follow up results after TCC of large PDAs with severe pulmonary arterial hypertension (PHT) in children.This is a observational study of 38 patients with Large PDA and severe PHT who were referred to this centre for treatment during the period from July 2015 to Feb 2018 . After evaluating clinical and hemodynamic parameters reversibility of severe PAH was established and transcatheter closure of PDA was performed. Patients were followed up clinically and echocardiographically at 24 hours, 1 month, 3 months, 6 months, 12 months and 24 months to assess the efficacy, safety of the procedure & its impact on PHT. Thirty eight patients, (26 females, 12males) patients between 6 months to 16 years of age had underwent successful device closure. 18 patients had PDA sizes between 6-8 mm,12 had between 8- 10 mm , 6 had between 10-15mm and only 2 patients had largest PDA more than 15 mm at PA end . 5 patients were selected for closure with muscular VSD device . We have successfully closed 3 of our largest PDA (12 mm , 16mm and 18mm) with Post Infarct Muscular VSD Occluder measuring 20 mm,22 mm and 24 mm respectively. TCC of hypertensive but reversible PDA is feasible. The immediate and short-term outcomes have proven this method to be safe and valid.