Presentation for congress for milan ipc 21th march 2013
Immediate and Intermediate Results of Patent Ductus Artriosus Transcatheter Closure in Kurdistan (Kurdistan Multicenter experience) Presented By Dr. Aso Faeq Salih Sulaimany University, college of medicine , Pediatric Dept ., kurdistan/Iraq MBChB,DCH,FIBMS(Ped.), MSc (P.cardiology ) Dr. Abass Alrabaty Dr.Zuhair alnasiry MBChB,DCH,FIBMS(Ped.) MBChB,MD,MSc (cardiology)21th March. 2013 email@example.com
Aim of the study:• Is to evaluate the immediate and intermediate results of first experience PDA closure in three centers of Iraqi Kurdistan, using both types of Amplatzer PDA I and II devices
Materials and method• The study was conducted from March 2008 to February 2011• Involving all 3 centers in Kurdistan namely Hawler , Sulaimany and Duhok .• A total of 290 patients enrolled in this study in which closure done for 270 cases .• The procedures performed by different local and international operators• Included patients in the study had echocardiographic or angiographic evidence of a PDA• The exclusion criteria for this study were pulmonary vascular resistance above 8 indexed Wood’s units and associated complex congenital heart disease.
Each patient underwent complete 2-D echocardiography and Doppler looking for residual shunting and any evidence of obstruction in 1st 24 hours.• All patients were reviewed clinically and with repeat 2-D echocardiography at 1 , 6 and 12 months.
Balloon occlusion test before closure Snaring from arterial side Embolization
Graph shows age distribution among PDA cases• 1-5 years 37% mean age is (6.3 +/- 6.5 years• 6-10 years 31% mean weight of (11.5+/- 7.5 kg)
Discussion• The ratio of M: F in Kurdistan study is 1 : 2.8• in Kurdistan study we have 94.6% complete closure rate closure rates , compared to studies done in Greece5 which was 93% closure rate at near the same average weight and ages .• Foaming (trace angiographic residual shunt with no contrast jet) was seen in 85 cases account for 32.1% of cases in which it disappears after 10-15 min of closure.
• Follow up closure rate by echocardiography after 1 , 6 and 12 months follow shows 99.5% closure rate as in the study done in Malaysia2 closure rate after 6 months of device closure was 99% .49 and in another study done in USA1 as multicenter trial shows 98% closure rate after one year and also in Yemeni 4 experience complete closure was in all patients after 12 months of closure.• No LPA stenosis and aortic obstruction observed although one of the cases got mild gradient across descending aorta at aortic disc level with no complication on follow up.• No patient required blood transfusion; there were no major femoral venous and arterial complications .1 Robert H. Pass, MD, Ziyad Hijazi, MD,Daphne T. Hsu, MD, Veronica Lewis, RN, William E. Hellenbrand, MD, Multicenter USA Amplatzer Patent Ductus Arteriosus Occlusion Device Trial Initial and One-Year Results; JACC, 2004; 44(3):513–92 Bilkis et al.,the amplatzer duct occlude : experience in 209 patients , JACC,2001; 37( 1).
• Misplacement of the ADO across the PDA occurred in 12 of our patients and was easily corrected by retracting the device into a large sheath and redeploying it.• No recanalization , migration , theromboembolic episodes, hemolysis or endocarditis noted after 12 months follow up
The mean fluoroscopy time for Kurdistan study was 6.13 min as compared with other study done in Greece5 mean floro time was 7.9min , also Yemini4 study mean fluoroscopy time was 13.7minutes and another study in USA was 7.1min 3Pass et al., USA Amplatzer PDA Occlusion Device Trial, JACC, 2001; 4434 Ahmed Al-Motarreb, Mohammed Al-Hammadi, Mohammed Shamsan, percutaneous transcatheter closure of patent ductus artiosus using amplatzer duct occlude: first Yemeni experience; HEART VIEWS VOLUME 7 NO. 3 SEPTEMBER – NOVEMBER 2006:101 – 1045 Thanopoulos et al., PDA Closure with the Amplatzer Duct Occluder, JACC, 2000; 35(4):1016–21
Conclusion: we conclude that PDA closure with Amplatzer Type I and II are safe and effective for treating patients with these favorable kinds of PDA morphologically
Recommendation: From our results of Kurdistan in all three centers we recommend that PDA in different kinds and shapes can be effectively treated by Amplatzer device type I , and Amplatzer PDA device II for those PDAs with long restrictive shape that cannot be closed by ordinary Amplatzer I device We recommend routine better taking hemodynamics parameters
Happy new Year ( NAWROZ ) for Kurdish People1.1.2713and also for all Persian and Aryan people in westAsia