Next article Search Articles Instructions for authors  Access Statistics | Citation Manager  
ORIGINAL ARTICLE  

 Article Access Statistics
    Viewed1858    
    Printed28    
    Emailed0    
    PDF Downloaded184    
    Comments [Add]    

Recommend this journal

Percutaneous closure of patent arterial ducts in patients from high altitude: a sub-Saharan experience


1 Department of Pediatrics and Child Health, Cardiology Division, School of Medicine, Addis Ababa University and Cardiac Center, Addis Ababa, Ethiopia
2 Department of Pediatric Cardiology, Evelina London Children's Hospital, Guys and St. Thomas' Foundation Trust, London, United Kingdom
3 Department of Pediatric Cardiology, Ramon y Cajal University Hospital, Madrid, Spain
4 Department of Pediatric Cardiology, La Paz Hospital, Madrid, Spain

Correspondence Address:
Endale Tefera
Department of Pediatrics and Child Health, School of Medicine, Addis Ababa University, P. O. Box 1768, Addis Ababa
Ethiopia
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-2069.164690

Rights and Permissions

Year : 2015  |  Volume : 8  |  Issue : 3  |  Page : 196-201

 

SEARCH
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles

  Article in PDF (474 KB)
Email article
Print Article
Add to My List
Background : At high altitude, patent arterial ducts tend to be larger and associated with pulmonary hypertension. Patent ductus arteriosus device closure in this background could be challenging. Objectives : We report our experience with percutaneous closure of patent arterial ducts using a variety of devices in patients residing in a high altitude. Patients and Methods : This is a retrospective review of the case records of 145 patients (age 9 months-20 years, mean 5.6 ± 3.9 years, and weight 7-54 kg, mean 17.7 ± 9.4) with duct sizes ranging between 2 and 21 mm, (mean, 5.8 ± 2.7) who underwent percutaneous closure of patent arterial ducts. One hundred thirty-six (93.8%) of the patients were from a geographic area of 2100-2800 m above sea level. Results : Successful device closure was achieved in 143 cases. It was difficult to achieve device stability in two patients with expansile ducts. Therefore, they were treated surgically. The devices used were various types of duct occluder devices in 131 patients, while atrial and ventricular septal occluders were used in eight patients. For the group, mean systolic pulmonary artery (PA) pressure decreased from 47.0 ± 16.7 mmHg before occlusion to 29.0 ± 7.4 mmHg after occlusion (P ≤ 0.001)., mean diastolic PA pressure from 25.0 ± 10.9 mmHg to 14.8 ± 6.0 mmHg and the average mean PA pressure decreased from 35.9 ± 13.5 mmHg to 21.1 ± 6.5 mmHg. Complications (4.8%) included device and coil embolization, bleeding, and pulse loss. On follow-up (mean duration of 36.1 ± 12.1 months, range 12-62 months), 137 patients were in functional class 1, 3 had residual shunt, 2 had device migration and one patient had persisting pulse loss. Conclusions: Successful duct closure was achieved in the vast majority of patients, even though the ducts were larger and significant number of them had pulmonary hypertension in this high altitude group. There was a relatively higher incidence of residual shunts and device migration in this series, generally due to the nonavailability of optimal device and surgical support. Long-term follow-up is required before we can draw conclusions with regard to the sustainability of drop in PA pressures. Septal Occluder devices may be a possible alternative for large tubular or window-type ducts with severe pulmonary hypertension, where there may be concerns about the size and stability of duct occluder devices.






[FULL TEXT] [PDF]*
 

 

 

 Next article
 Previous article
 Table of Contents

 Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
 
 
 Reader Comments
 Email Alert *
  *
 * Requires registration (Free)
 
 ORIGINAL ARTICLE
 




1 Department of Pediatrics and Child Health, Cardiology Division, School of Medicine, Addis Ababa University and Cardiac Center, Addis Ababa, Ethiopia
2 Department of Pediatric Cardiology, Evelina London Children's Hospital, Guys and St. Thomas' Foundation Trust, London, United Kingdom
3 Department of Pediatric Cardiology, Ramon y Cajal University Hospital, Madrid, Spain
4 Department of Pediatric Cardiology, La Paz Hospital, Madrid, Spain

Correspondence Address:
Endale Tefera
Department of Pediatrics and Child Health, School of Medicine, Addis Ababa University, P. O. Box 1768, Addis Ababa
Ethiopia
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-2069.164690

Rights and Permissions

Background : At high altitude, patent arterial ducts tend to be larger and associated with pulmonary hypertension. Patent ductus arteriosus device closure in this background could be challenging. Objectives : We report our experience with percutaneous closure of patent arterial ducts using a variety of devices in patients residing in a high altitude. Patients and Methods : This is a retrospective review of the case records of 145 patients (age 9 months-20 years, mean 5.6 ± 3.9 years, and weight 7-54 kg, mean 17.7 ± 9.4) with duct sizes ranging between 2 and 21 mm, (mean, 5.8 ± 2.7) who underwent percutaneous closure of patent arterial ducts. One hundred thirty-six (93.8%) of the patients were from a geographic area of 2100-2800 m above sea level. Results : Successful device closure was achieved in 143 cases. It was difficult to achieve device stability in two patients with expansile ducts. Therefore, they were treated surgically. The devices used were various types of duct occluder devices in 131 patients, while atrial and ventricular septal occluders were used in eight patients. For the group, mean systolic pulmonary artery (PA) pressure decreased from 47.0 ± 16.7 mmHg before occlusion to 29.0 ± 7.4 mmHg after occlusion (P ≤ 0.001)., mean diastolic PA pressure from 25.0 ± 10.9 mmHg to 14.8 ± 6.0 mmHg and the average mean PA pressure decreased from 35.9 ± 13.5 mmHg to 21.1 ± 6.5 mmHg. Complications (4.8%) included device and coil embolization, bleeding, and pulse loss. On follow-up (mean duration of 36.1 ± 12.1 months, range 12-62 months), 137 patients were in functional class 1, 3 had residual shunt, 2 had device migration and one patient had persisting pulse loss. Conclusions: Successful duct closure was achieved in the vast majority of patients, even though the ducts were larger and significant number of them had pulmonary hypertension in this high altitude group. There was a relatively higher incidence of residual shunts and device migration in this series, generally due to the nonavailability of optimal device and surgical support. Long-term follow-up is required before we can draw conclusions with regard to the sustainability of drop in PA pressures. Septal Occluder devices may be a possible alternative for large tubular or window-type ducts with severe pulmonary hypertension, where there may be concerns about the size and stability of duct occluder devices.






[FULL TEXT] [PDF]*


        
Print this article     Email this article