Patent Ductus Arteriosus In Children Research Articles

Percutaneous Closure of Patent Ductus Arteriosus in Children Using ADO I and ADO II Devices: A Thirteen Year Single Centre Experience

Percutaneous Closure of Patent Ductus Arteriosus in Children Using ADO I and ADO II Devices: A Thirteen Year Single Centre Experience

Different interventions for the treatment of patent ductus arteriosus in children: a protocol for a network meta-analysis

IntroductionPatent ductus arteriosus (PDA) is one of the most common congenital heart diseases. Once the PDA is diagnosed, it needs to be dealt with in time. At present, main methods include pharmacological treatment, surgical closure, and interventional closure for treatment of PDA. However, the effect of different interventions in PDA management is still controversial. Thus, our study aims to assess the effectiveness of different interventions together and estimate the sequence of these therapies for PDA children. Meanwhile, it is necessary to conduct a Bayesian network meta-analysis to compare the safety of different interventions comprehensively.Methods and analysisTo the best of our knowledge, this is the first Bayesian network meta-analysis comparing the efficacy and safety of different interventions for the treatment of PDA. PubMed, Embase, Cochrane Library, Web of Science, gray literature, and trial registry databases were searched from inception to December 2022. We will extract and report data according to methodological guidelines for Bayesian network meta-analysis by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P). Primary PDA closure, overall PDA closure, technical success, surgical success rate, mortality during hospital stay, operation time, intensive care unit stay, intraoperative radiation dose, radiation exposure time, total postoperative complication rate, and postoperative major complication rate will be defined as the outcomes. The quality of all random studies will be assessed using ROB, and quality of evidence for all outcomes will be judged by using the Grading of Recommendations Assessment, Development and Evaluation (GRADE).Ethics and disseminationThe results will be disseminated through peer-reviewed publication. Since no private and confidential patient data will be contained in the reporting, there are no ethical considerations associated with this protocol.Systematic review registrationINPLASY2020110067.

Role of angiography procedure for assessment the type of patent ductus arteriosus in children under 18 years.

Objective: To determine the role of angiography for the assessment the type of patent ductus arteriosus in children under 18 years. Study Design: Observational Retrospective study. Setting: Children’s Hospital Lahore. Period: October 2021 to February 2022. Material & Methods: The sample size calculated was 245 but, at the end of the period of four months only 120 patients fulfilled the criteria and were included in this study convenient sampling technique was used to collect the data. Patients with patent ductus arteriosus were included in this study. Patients with other congenital heart diseases were excluded. Essential measurements included Types of Patent Ductus Arteriosus (PDA), (PDA) Size, Ampulla Size, Aortic and Pulmonary systolic and diastolic pressures. Results: In this study 120 patients with PDA were included. Out of 120, 38 (31.7%) patients were male and 82 (68.3%) patients were female. The age range of the patients was 8 months to 18 years (mean;5.44 ± 3.972 years). The weight range of the patients was 5.3 to 41 Kg (mean;16.05 ± 8.38Kg). The mean PDA size was 4.01 ± 1.80. The mean Ampulla size was 9.92 ± 3.13. The types of PDA detected by angiography were Type A 59(49%), Type B 15(12.5%), Type C 20(16.7%), Type D 20(16.7%), Type E 5(4%), Type F 1(0.8%). The mean Aortic systolic pressure was 105.5±18.99 and diastolic pressure was 57.2 ±14.4. The mean Pulmonary Artery systolic pressure was 47.4 ± 23.3 and diastolic pressure was 27.7 ±14.2. Conclusion: Angiography was found more accurate for the assessment of all the anatomical types of PDA especially TYPE B, C, D and F. More precise measurements of the ampulla and PDA sizes were obtained using angiography. We may conclude that Angiography is a much better and good modality than other modalities for the assessment of the types of PDA.

Myocardial injury and inflammatory response in percutaneous device closures of pediatric patent ductus arteriosus

BackgroundThe percutaneous device closure of patent ductus arteriosus (PDA) is widely used in clinical practice, however full data on the changes in myocardial injury and systemic inflammatory markers’ levels after PDA in children are not fully reported.MethodsWe have conducted a retrospective analysis of the medical records of 385 pediatric patients in our hospital from January 2017 to December 2019. The patients were distributed into five groups. The first four (A, B, C and D) included patients divided by the type of the surgical closure methods, namely ligation, clamping, ligation-combined suturing and ligation-combined clamping, respectively. The fifth group E comprised of percutaneous device PDA patients. All recorded medical and trial data from the five groups were statistically studied.ResultsNo serious complications in the patients regardless of the classification group were reported. Our results suggested that there were no considerable differences between the groups at the baseline (with all P > 0.05). Group E demonstrated a significantly smaller operative time (42.39 ± 3.88, min) and length of hospital stay (LOS) (4.49 ± 0.50, day), less intraoperative blood loss (7.12 ± 2.09, ml) while on the other hand, a higher total hospital cost (24,001.35 ± 1152.80, RMB) than the other four groups (with all P < 0.001). Interestingly, the comparison of the inflammatory factors such as white blood cells (WBC) count, C-reactive protein (CRP), procalcitonin (PCT) and interleukin-6 (IL-6), as well as the myocardial injury markers (CKMB and troponin I) did not show a significant increase (P > 0.05) among the four groups. On the contrary, when the aforementioned factors and markers of all the surgical groups were compared to those in group E, we observed significantly higher speed and magnitude of changes in group E than those in groups A, B, C, and D (with all P < 0.001).ConclusionAlthough the percutaneous device closure of PDA is more comforting and drives fast recuperation in comparison to conventional surgery, it provokes myocardial injury and overall inflammation. Timely substantial and aggressive intervention measures such as the use of antibiotics before operation and active glucocorticoids to suppress inflammation and nourish the myocardium need be applied if the myocardial and inflammatory markers are eminent.

Transcatheter closure of tubular patent ductus arteriosus using muscular ventricular septal defect devices in infants and small children with congestive heart failure

Transcatheter closure of a patent ductus arteriosus in children is widely performed to reduce symptoms and decrease the risk of endocarditis. Most arterial ducts are closed successfully with dedicated devices. However, in a tubular or "type C" patent ductus arteriosus with congestive heart failure, the occlusion is more challenging with these devices, with a higher risk of complications, such as aortic or left pulmonary stenosis and device embolization. To report our experience with muscular ventricular septal defect devices for patent ductus arteriosus occlusion in small children. Retrospective observational series of patients weighing<10kg, with a tubular patent ductus arteriosus (typeC) and congestive heart failure, who underwent transcatheter closure with a muscular ventricular septal defect device between 2017 and 2019. Eight patients were included. The mean age and weight at closure were 6.3 months (range 1-18 months) and 5.3kg (range 2.4-8.2kg), respectively. All patent ductus arteriosus were occluded successfully using Occlutech® (N=3) or Amplatzer® (N=5) muscular ventricular septal defect devices. In four cases, the muscular ventricular septal defect device was used after failure to close the patent ductus arteriosus with a dedicated patent ductus arteriosus device. Two patients had mild left pulmonary artery stenosis, with a maximum velocity on continuous Doppler of 3m/s and 2.7m/s, respectively. After a mean follow-up of 28 months (range 14-41 months), all patients were asymptomatic with excellent results. The mild pulmonary stenosis improved, with a maximum velocity of 2.3m/s in both patients. Closure of tubular patent ductus arteriosus in small children with congestive heart failure using a muscular ventricular septal defect device is safe in this preliminary experience. Further studies with more patients are warranted.

Is Two Dimensional Echocardiography sufficient for selection of device for successful transcatheter closure of Patent Ductus Arteriosus in Children?

Background and Aims: Two dimensional transthoracic echocardiography (2DE) is widely used for detecting congenital heart disease and is possible to obtain precise measurement of Patent ductus arteriosus (PDA) for device selection required for transcatheter closure. Primary aim of the study is to determine whether echocardiographic assessment alone can be used for selection of device for transcatheter closure of PDA.&#x0D; Methods: Children with PDA and planned for transcatheter intervention were included in this cross-sectional study of one year. PDA was assessed with 2DE and prediction of device size was made.&#x0D; Results: The results were obtained from 107 children. The median age and weight at intervention were 3.8 years (ranging from 6 months to14 years) and 12 kg (ranging from 3.5 to 60 kg). Type A (Conical) PDA was the commonest PDA morphology accounting for 87.8% and 85% in 2DE and angiography respectively. There was no difference (p &lt; 0.05) in the narrowest diameter at pulmonary end measured by 2DE and angiography, however ampulla diameter and ductal length were statistically different (p = 0.95). The predicted size of device by 2DE was discordant (p &lt; 0.05) to the actual device used in a total study population, however when patients with severe pulmonary hypertension, non-type A and larger PDA (narrowest diameter &gt; 6mm) were excluded, the predicted size of device by 2DE was statistically concordant (p = 0.1) to the actual device used in 89 (83%) patients.&#x0D; Conclusion: Two dimensional Transthoracic echocardiography alone may be helpful in choosing the device during transcatheter closure of PDA in selective group of patients.

Safety and Outcomes of Transcatheter Closure of Patent Ductus Arteriosus in Children With Pulmonary Artery Hypertension.

To investigate whether transcatheter device closure of patent ductus arteriosus (PDA) is safe in children with pulmonary artery hypertension, we retrospectively analyzed our experience with 33 patients who underwent the procedure from January 2000 through August 2015. Pulmonary artery hypertension was defined as a pulmonary vascular resistance index (PVRI) >3 WU · m2. All 33 children (median age, 14.5 mo; median weight, 8.1 kg) underwent successful closure device implantation and were followed up for a median of 17.2 months (interquartile range [IQR], 1.0-63.4 mo). During catheterization, the median PVRI was 4.1 WU · m2 (IQR, 3.6-5.3 WU · m2), and the median mean pulmonary artery pressure was 38.0 mmHg (IQR, 25.5-46.0 mmHg). Premature birth was associated with pulmonary vasodilator therapy at time of PDA closure ( P=0.001) but not with baseline PVRI (P=0.986). Three patients (9.1%) had device-related complications (one immediate embolization and 2 malpositions). Two of these complications involved embolization coils. Baseline pulmonary vasodilator therapy before closure was significantly associated with intensive care unit admission after closure (10/12 [83.3%] with baseline therapy vs 3/21 [14.3%] without; P <0.001). Of 11 patients receiving pulmonary vasodilators before closure and having a device in place long-term, 8 (72.7%) were weaned after closure (median, 24.0 mo [IQR, 11.0-25.0 mo]). We conclude that transcatheter PDA closure can be performed safely in many children with pulmonary artery hypertension and improve symptoms, particularly in patients born prematurely. Risk factors for adverse outcomes are multifactorial, including coil use and disease severity. Multicenter studies in larger patient populations are warranted.

Percutaneous Closure of the Patent Ductus Arteriosus in Very Low Weight Infants: Considerations Following US Food and Drug Administration Approval of a Novel Device

Percutaneous Closure of the Patent Ductus Arteriosus in Very Low Weight Infants: Considerations Following US Food and Drug Administration Approval of a Novel Device

Transcatheter closure of patent ductus arteriosus in children weighing 5 kg or less: Initial experienc

Introduction: Trans-catheter closure (TCC) of patent ductus arteriosus (PDAs) is a well-establishednon-surgical method of closure. Objectives: To evaluate safety, feasibility &amp; complicationsof device closure of patent ductus arteriosus (PDA) in small children weighing ≤ 5 kg with different types of devices for closure. Methods: patients with PDA underwent transcatheter closure, among whom 16 (33%) weighed 5 kg or less. All of these patients underwent transcatheter closure of PDA using an Amplatzer duct occluder I, Amplatzer duct occluder II or Amplatzer duct occluder 2 IIAS (Additional size) devices. Results: Sixteen patients (9 females &amp; 7 males) between theages 20 days to 16 months had undergone device closures. Amplatzer Duct Occluder (ADOI) was used in 12 cases, 3 were closed with Amplatzer Duct Occluder (ADO2) and one the smallest of all (1.6 kg) patientwere selected for closure with Amplatzer Duct Occluder (ADO2 AS).At 1 month after the closure, the signs and symptoms improved markedly in all patients, and PDAs were completely closed and devices remained in situ on follow-up. Mild obstruction of left pulmonary artery (n=2) and aortic isthmus flow (n=1) was noted at the time of discharge which gradually improved on follow up. Conclusions: TCC of PDAin small babies 5 kg or less is feasible &amp; safe alternative to surgical PDA closure in carefully selected patients. The immediate &amp; short-term outcomes have proven this method to be safe &amp; valid.

Cocoon devices for transcatheter closure of atrial septal defect and patent ductus arteriosus in children: Single center experience.

Closure of the atrial septal defect (ASD) and patent ductus arteriosus (PDA) are among the most frequent cardiac interventional procedures. This was a prospective study, which started together with the implementation of a national program of pediatric interventional cardiology in Romania. We used Cocoon devices in 83 consecutive cases from 92 implantations for ASD and PDA. 27 cases were ASD closure and 56 cases PDA closure. Regarding the ASD closure, the median age was 8.5 years (range 3–25 years) and median weight 25 kg (range 11.5–63 kg). The mean follow-up was 17.4 ± 6.7 months (range 3–26 months). The mean ASD diameter by transesophageal echocardiography was 15.2 ± 4.1 mm (range 8–26 mm). The mean device diameter used was 17.3 ± 5.6 mm (range 8–32 mm). Regarding the PDA closure, the median age was 36 months (range 4–192 months) and median weight 14 kg (range 5–58 kg). The mean follow-up was 15 ± 8 months (range 3–28 months). The mean PDA minimum diameter was 2.5 ± 0.8 mm. The success implantation rate for both groups was 97.6% (2 cases of withdrawn for ASD and PDA), while the complication rate was 2.3% (including 2 ASD device embolization). In the first 24 hours, the closure rates were 96.3% for ASD, 98.2% for PDA, and 100% at 1-month follow-up for both procedures. On short and intermediate follow-up (3–28 months), no device-related complications were noted.The Cocoon devices are safe for transcatheter closure of both ASD and PDA, and the initial experience with their use in our emerging center is encouraging.

PATENT DUCTUS ARTERIOSUS;

Background: Patent Ductus Arteriosus (PDA) is a congenital cardiacdisease of children. Lot of work has been done to evaluate the usefulness ofmanagement procedure including medical management and surgery but there isno evidence to evaluate the risk factors associated with PDA. Aim: To find out theassociation of risk factors leading to patent ductus arteriosus in children. Method: Acase control study was conducted on 240 children, out of which 120 were cases and120 were controls. Children of 1-15 years of either gender were included in the studythrough Simple Random sampling technique. Parents were called for interview andhistory of risk factors leading to PDA were asked and noted on questionnaire. Datawas entered and analyzed through the computer software, SPSS version 21. Results:In this study, we included 240 children with the mean age of 4.86±4.01 years. Therewere 88 (37%) males while 152 (63%) were females. The male-to-female ratio was 1:1.7.The mean height of children was 3.52±1.18 feet and the mean weight of children was24.98±11.34kg. Through logistic regression, it was observed that family history, overthe counter drugs or antibiotic use during pregnancy, Down’s syndrome and pretermbirth were significantly effecting the occurrence of PDA (P&lt;0.05), while female gender,smoking status of father and infection during pregnancy including rubella becomeinsignificant (P&gt;0.05). In logistic regression, it was observed that family history, overthe counter drugs or antibiotic use during pregnancy, Down’s syndrome and pretermbirth were significantly affecting the occurrence of PDA (P&lt;0.05). Conclusion: Femalegender, preterm birth, infection during pregnancy and use of over the counter drugsin pregnancy, female’s exposure to smoking and multiple drugs and low birth weightare significant risk factors associated with PDA.

English

Background: Patent Ductus Arteriosus (PDA) is a congenital cardiacdisease of children. Lot of work has been done to evaluate the usefulness ofmanagement procedure including medical management and surgery but there isno evidence to evaluate the risk factors associated with PDA. Aim: To find out theassociation of risk factors leading to patent ductus arteriosus in children. Method: Acase control study was conducted on 240 children, out of which 120 were cases and120 were controls. Children of 1-15 years of either gender were included in the studythrough Simple Random sampling technique. Parents were called for interview andhistory of risk factors leading to PDA were asked and noted on questionnaire. Datawas entered and analyzed through the computer software, SPSS version 21. Results:In this study, we included 240 children with the mean age of 4.86±4.01 years. Therewere 88 (37%) males while 152 (63%) were females. The male-to-female ratio was 1:1.7.The mean height of children was 3.52±1.18 feet and the mean weight of children was24.98±11.34kg. Through logistic regression, it was observed that family history, overthe counter drugs or antibiotic use during pregnancy, Down’s syndrome and pretermbirth were significantly effecting the occurrence of PDA (P&lt;0.05), while female gender,smoking status of father and infection during pregnancy including rubella becomeinsignificant (P&gt;0.05). In logistic regression, it was observed that family history, overthe counter drugs or antibiotic use during pregnancy, Down’s syndrome and pretermbirth were significantly affecting the occurrence of PDA (P&lt;0.05). Conclusion: Femalegender, preterm birth, infection during pregnancy and use of over the counter drugsin pregnancy, female’s exposure to smoking and multiple drugs and low birth weightare significant risk factors associated with PDA.

Echocardiography in the differential diagnosis of patent ductus arteriosus in children

The aim of this study was to attempt to carry out the analysis and interpretation of the clinical course of the disease in children with documented congenital heart disease - patent ductus arteriosus. To compare the data with the size of auscultation of patent ductus arteriosus and the direction to be bypassed through the blood stream, obtained during routine echocardiography. Using echocardiography to examine abnormal diastolic flow in the pulmonary artery trunk, simulating patent ductus arteriosus. Echocardiography was performed in 2173 a child under the age of 1 day of life to 18 years. Of these outpatient echocardiographic study was performed in 1503 children permanently surveyed 670 children. Patent ductus arteriosus was diagnosed in 66 children, which made up 3% of the total surveyed. Of these, 48 girls and 18 boys (ratio 2.6 : 1). In the classification of the identified patent ductus arteriosus, we have a new form of it has been identified and proposed - a continuously recurrent, which met in 5 children. When comparing the data auscultation with different kinds of patent ductus arteriosus was found that the classic “machine” systolic-diastolic murmur, accompanied by only 20% of defects, 60% of the children to listen to a systolic murmur in the 2-3 intercostal space on the left in the sternum, in some cases accompanied by focus 2nd tone of the pulmonary artery. The remaining 20% of the children surveyed, a significant auscultatory pattern generally absent. The paper presents the criteria for echocardiographic diagnosis between patent ductus arteriosus, and pulmonary and aorto-coronary-pulmonary fistulas, and fistulas. It is shown that when rendering the bifurcation of the pulmonary artery from the left parasternal short-axis access, deficiency or complete absence of tissue in the projection of aorto-pulmonary ligaments (ligamentum arteriosum), may indicate the presence of a patent ductus arteriosus.

Transcatheter closure of patent ductus arteriosus in children weighing 10 kg or less: Initial experience at Sohag University Hospital

AimTo assess the challenges, feasibility, and efficacy of device closure of patent ductus arteriosus (PDA) in small children weighing ⩽10kg for different types of devices used in an initial experience at Sohag University hospital. MethodsBetween March 2011 and September 2014, 91 patients with PDA underwent transcatheter closure in our institute, among whom 54 weighed ⩽10kg. All of these patients underwent transcatheter closure of PDA using either a Cook Detachable Coil, PFM Nit-Occlud, or Amplatzer duct occluder. A retrospective review of the treatment results and adverse events was performed. ResultsSuccessful device placement was achieved in 53/54 small children (98.1%). The median minimum PDA diameter was 2.4mm [interquartile range (IQR, 1.8–3.5mm), median weight 8kg (IQR, 7–10kg), and median age 10months (IQR, 8–17months)]. Mild aortic obstruction occurred in one case (1.9%), as the device became displaced towards the aorta after release. The device embolized in one case (1.9%) and no retrieval attempt was made. Five cases (9.3%) had minor vascular complications. ConclusionWith the current availability of devices for PDA closure, transcatheter closure of PDA is considered safe and efficacious in small children weighing ⩽10kg with good mid-term outcome. The procedure had a low rate of high-severity adverse events even with the initial experience of the catheterization laboratory.

ASSA14-14-04 Transcatheter Closure of Patent Ductus Arteriosus in Children with Body Weight ≤ 8 kg

Background To explore the interventional experience and safety, efficiency of transcatheter closure of patent ductus arteriosus (PDA) in children with body weight ≤8 kg. Methods From May 2001 to August 2013,102 children with body weight ≤8 kg were diagnosed PDA. All patients were underwent transcatheter closure and aorta descendens angiography 6 min after the closure. To observe the therapeutic efficacy, we examed X-ray, ECG and echocardiography 24 h, 1 month, 3 month and 6 month after operation. Results In 102 patients, male 27, female 75, aged from 3 months to 2 years(0.9 ± 0.5 years), body weight from 5 to 8 kg (7.2 ± 0.9) kg.In 102 patients, there were funnel PDA 58, tubular PDA 39, window PDA 1 and irregular PDA 4. The narrowest PDA diameter of pulmonary artery side was 2∼10 (4.8 ± 1.6) mm by aortography. 25 patients used Amplatzer company PDA mushroom occluders, 5 patients used new type Amplatzer ADO-II occluders and 1 patient used Amplatzer Plug. 69 patients used domestic-made PDA mushroom occluders, 2 patients used domestic-made VSD occluders. The mushroom occluders waist diameter was from 6 to 16 mm. 87 patients mean pulmonary pressure were ≥25 mmHg and 43 patients mean pulmonary pressure were ≥50 mmHg before occlusion. The mean pulmonary pressure decreased with different extent after occlusion, which were consistent with dynamic pulmonary artery hypertention. 102 patients were all cured successfully and the closure achievement ratio was 100%. Conclusions PDA patients with low body weight had their own specificness. Interventional therapy has its risk. However, it is still a safe methods to treat PDA if we performed the procedure with cautiousness, selected occluder appropriately and prevent the complication.

Transcatheter patent ductus arteriosus closure with echocardiographic guidance: can radiation exposure be reduced?

The radiation dose from interventional cardiac catheterization is particularly relevant when treating children because of their greater radiosensitivity compared to adults. The transcatheter closure of patent ductus arteriosus (PDA), as well as other more complex pediatric interventions, have raised concerns regarding radiation exposure, particularly relevant when treating children. The purpose of this study is to show how to perform the transcatheter closure of PDA in children while giving less ionized radiation and to prove that the amount of radiation and contrast material can be reduced. Following appropriate device selection based on PDA morphology and diameter, transthorasic echocardiography images and control aortography findings were analyzed. The following devices were used during the procedure: Gianturco coils (10/63), an Amplatzer Duct Occluder (ADO, 31/63), Flipper coils (19/63), and an Amplatzer vascular plug (3/63). The scopy time, radiation dose, and contrast were 12 ± 6.4 mins, 28.1 ± 14.7 cmGy/cm²/kg, and 4.2 ± 2.3 cc/kg, respectively. In the control aortography shortly after the procedure, residual shunt was detected at various levels in 39.7% of patients, and 9.5% demonstrated residual shunt in real-time echocardiography. In the control aortography, the exposure to radiation was 13.3% of the total, and the amount of infused contrast was 27.2% of the total. Patients may be exposed to less radiation and contrast material if an echocardiographic evaluation, instead of a final control aortography injection, is performed after the transcatheter closure of PDA.

Thoracoscopic closure of patent ductus arteriosus in children

Background Patent ductus arteriosus is a common congenital disorder (10% of congenital disorders). Ductus Botalli closure is the realm of invasive cardiology. Inability to perform ductus Botalli closure with percutaneous methods causes, that administration of indomethacin or surgery are nowadays treatment of choice. The aim is to present an alternative in treatment with minimally invasive surgery, such as video-assisted thoracoscopic closure of PDA.

GW24-e2156 Transcatheter closure of patent ductus arteriosus in children with body weight less than or equal 8Kg

ObjectivesTo explore the interventional experience of transcatheter closure of patent ductus arteriosus (PDA) in children with body weight ≤ 8Kg.MethodsFrom May 2001 to October 2012, 81 children with body weight...

Closure of patent ductus arteriosus in children, small infants, and premature babies with Amplatzer duct occluder II additional sizes: Multicenter study

To evaluate safety and efficacy of closure of patent ductus arteriosus (PDA) with Amplatzer duct occluder II Additional Sizes (ADO II AS) and to report early and midterm results of the device in children and very young symptomatic infants. Retrospective analysis of angiographic data of 60 children from four pediatric cardiology centers. The median patient age and weight were 6.5 (0.5-168) months and 6.8 (1.19-57) kg, respectively. In the study, 26 children had a body weight of ≤ 6 kg. Of these 26 children, 9 had a body weight of ≤ 3 kg. The median narrowest diameter of PDA was 2 (1.2-4) mm. Ductal anatomy was Type A in 29, Type B in 2, Type C in 11, Type D in 1, and Type E in 16 patients, and a residual PDA after surgery in 1 patient. Closure with ADO II AS was achieved in 58 (96.6%) of 60 attempted cases. In two infants, the device was not released because of significant residual shunt. ADO II was used in one, and the other was sent to surgery. Complete closure was observed in all ADO II AS deployed children by the next day on echocardiography. Median follow-up was 12 (1-18) months. Neither death nor any major complications occurred. Our study shows that closure of medium and small sized PDA by using ADO II AS device is effective and safe in children. The use of the device will expand the field of application of PDA closure in small infants.

Frequency of Etiological Factors Leading to Patent Ductus Arteriosus

Abstract Background: Patent Ductus Arteriosus (PDA) is dev-eloping as major problem in our society. Many studies in Pakistan has been done to analyze the efficacy of surgical procedures but no one tried to find the fre-quency of factors leading to this problem. Objective: The purpose of this study was to find out the frequency of factors leading to patent ductus arte-riosus in children presented at Punjab Institute of Car-diology. Method: A cross sectional study was conducted on 242 patients of PDA who already have been treated during the year 2006 - 2007. They were interviewed on their regular follow up visits. Their operative infor-mation was gathered from their files. Results: Mean age of children at time of treatment was 6.12 + 5.203 years. Out of 242 children, there were more female (62.8%) as compared to male (37.2%). In this study, 17.8% children inherited the disease from their close relatives and 105 (43.4%) mo-thers had some infectious problems during pregnancy. 103 (42.6%) mothers used antibiotics or other drugs during pregnancy. 11 (4.5%) children had Down synd-rome. One hundred and thirty seven (56.61%) children had premature birth. Conclusion: Female gender, preterm birth, infection during pregnancy, mother's exposure to drugs and smoking, low birth weight may be etiological factors for development of PDA. Key Words: Etiological factors, Patent Ductus Arte-riosus, surgical ligation, catheter based procedure.