Fig 2 - uploaded by Oluwatoyin Ogunkunle
Content may be subject to copyright.
Aortography showing the French pigtail catheter in the descending aorta (AO) with contrast filling the pulmonary artery (PA through the duct (PDA) (arrowed)
Source publication
Since the first report on device closure of patent ductus arteriosus (PDA) by Porstmann et al in 1967, the procedure has gained wide acceptance and has been used all over the world, including parts of Africa. The advantages when compared to surgical closure include shorter procedure time and hospital stay and no scar being left. This mode of treatm...
Similar publications
Patent ductus arteriosus (PDA) in extremely low-birth-weight infants puts this vulnerable population at high risks of morbidity and mortality. Inclusion of a multidisciplinary team and newly available transcatheter PDA occlusion devices in the management of these infants can mitigate those risks and promote better long-term outcomes. It is importan...
Citations
... [7,8] Similarly, IC as a service for patients with cardiac lesions is not readily available in Nigeria. In October 2009, a private cardiac catheterization laboratory was opened in Lagos, majorly catering for adults, [9,10] but in October 2010, in collaboration with the Lagos State University College of Medicine/Lagos State University Teaching Hospital, a successful patent ductus arteriosus (PDA) device closure was performed on a 3-year-old girl, [11] the first of its kind in Nigeria. Since then, the same hospital has reported a few further device closures, both in adults and children. ...
... Our first patient for transcatheter device closure of PDA was a 3-year-old [2] who weighed 10 kg, whereas our first closure of ASD with a transcatheter device was in 34-yearold who presented with fainting spells of 1 month duration. ...
Congenital heart disease contributes significantly to the health burden of children in Nigeria. Interventions for congenital heart disease have been available in the developed world since the first report on device closure of patent ductus arteriosus (PDA) in 1967 by Porstmann. However, this did not start in Nigeria until October 2010. This study aimed to document the profiles of the patients who had undergone interventions for congenital heart diseases since the availability of the procedure, the challenges encountered, and the prospects associated with the interventions at the study site. All the patients referred to undergo interventions for congenital heart disease at the study center between October 2010 and 2012 were studied. The profile of the patient, including diagnosis at referral, indication for interventions, and interventions performed, were documented. The patients ranged in age from 3 to 62 years (mean age, 13.54 ± 17.7 years), and the male-to-female ratio was 1:3. The diagnosis at referral included PDA in 10 (83 %) of the 12 patients and secundum atrial septal defect in 2 patients (17 %). They all had transcatheter closure of the defects. Interventional procedures for congenital heart diseases currently are available locally, but the high degree of manpower training required, the cost, and the local availability of consumables are major factors limiting their use. Regional and international collaboration could be mutually beneficial.
Ventricular septal defect (VSD) is the most common congenital cardiac anomaly with a prevalence of 1.17 per 1000 live births. Haemodynamically significant VSDs require closure either surgical or transcatheter. We report a case of transcatheter device closure of a moderate-sized perimembranous ventricular septal defect (PmVSD), the first of its kind in Nigeria. The procedure was performed on a 23-month-old female weighing 10 kg who had presented with a history of frequent pneumonia and poor weight gain and signs of heart failure. The procedure was uncomplicated, and she was discharged 24 hours after the intervention. She had been followed-up two years post-procedure without complications and she had achieved appreciable weight gain. This non-surgical option was effective in this patient and provided the advantage of limited hospitalization, accelerated recovery, and intervention without the need for blood products. Such interventions should be scaled up in Nigeria and other sub-Saharan African countries.
Background:
Patent ductus arteriosus (PDA) is common among Nigerian children. It is the second only to ventricular septal defect among congenital heart diseases in Nigeria children. The study centers are the only centers in Nigeria which are able to offer both transcatheter closure of PDA and surgical ligation. The study aims to compare both methods in terms of the demographics of the individuals, cost and outcome.
Patients and methods:
Prospective, cross-sectional involving consecutive individuals who had either transcatheter closure or surgical ligation of PDA from June 2010 to January 2014. Individuals were grouped according to the method of closure of their defect. Data on their demographics, size of the defects, cost of treatment and outcome were compared for the two groups. The analysis was done using Microsoft Excel statistical software supplemented by Statistical Package for Social Sciences version 20.0. P < 0.05 was considered statistically significant.
Results:
A total number of 28 individuals had either surgical ligation or device closure of PDA done at the studied period. The mean age of all the individuals was 4.58 ± 4.20 years with a median age of 3 years. The mean age of individuals that had surgical ligation was 3.40 ± 0.92 years and mean age of those who had transcatheter device closure was 6.69 ± 1.05 years (P = 0.677). Male to female ratio in both groups were 0.4:1. No mortality was recorded in both groups. However, 6 (21.4%) of the surgical patients and 1 (3.57%) of the patient with device closure had complications. The direct cost of the procedure for each of the patient who had device closure of PDA was about $3000 whereas the cost of surgical closure was about $1000. The indirect cost for device closure was about $100 while that of surgical closure was about $5000.
Conclusion:
Device closure of PDA has lesser risk of complications compared to surgical ligation. Its indirect cost is also cheaper. There is a need for availability and accessibility to device closure of PDA in our environment.
