This document outlines the protocol for a thesis comparing catheter closure versus surgical ligation for patent ductus arteriosus (PDA) in small infants. The introduction provides background on PDA, current treatment options of surgery and catheterization, and the risks of leaving a PDA open. The aim is to compare the feasibility and short-term outcomes of catheter closure versus surgery. The methods section describes the inclusion/exclusion criteria for patients in the study and the procedures that will be performed, including clinical follow-up and echocardiography to assess for residual flow or complications post-intervention.

1. ‫آيه‬ ‫البقرة‬ ‫سورة‬
32

2. Patent Ductus Arteriosus Device
Closure Versus Surgical Ligation in Small
Infants
Protocol of thesis
Submitted for partial fulfillment of M.D. degree in Pediatrics
By
Islam Mohamed Sayed Hemeda
Master degree of pediatrics, faculty of medicine
Al Azhar University

3. Under supervision of
Prof. / Amal Mahmoud El Sisi
Professor of pediatrics-Faculty of medicine -Cairo University
Prof./ Mohamed Eldosoky Sharaa
Assistant professor of cardiothoracic surgery -Faculty of medicine-
Al-Azhar University
Dr./ Ibrahim Mohamed Abu Farag
Lecturer of pediatrics-Faculty of medicine- Al-Azhar University

4. INTRODUCTION

5. INTRODUCTION
 During fetal life, most of the pulmonary arterial blood is
shunted right to left through the ductus arteriosus into the
aorta. Patent ductus arteriosus (PDA) is a congenital heart
abnormality constituting nearly 10% of all congenital heart
anomalies. Its incidence is highest in premature babies and
twice more frequent in females than in males.

6. INTRODUCTION
 A hemodynamically significant ductus needs to be closed
by either surgery or interventional techniques at any age,
surgical repair of PDA is a safe, widely accepted procedure
with negligible mortality, it is associated with morbidity,
discomfort and a thoracotomy scar ,so surgical closure is
reserved for premature babies and for children with very
large PDAs.
Surgery is the mainstay of treatment for PDA. traditional
surgical approach, which entails a thoracotomy (or
alternatively, thoracoscopy).
 Therapeutic catheteziation is currently the treatment of
choice for most children and adults with a patent ductus.

7. INTRODUCTION
 Catheter closure of the ductus using several different
devices is having varying degrees of success. At many
centers, small ductus less than 3 mm in diameter are closed
by coils and larger ones by an Amplatzer PDA device.
 The Amplatzer Duct Occluder is a self-expandable,
mushroom-shaped device . The PDA is closed by the
induction of thrombosis, which is accomplished by polyester
fibers sewn securely into the device.

8. INTRODUCTION
 All PDAs should be closed because of the risk of bacterial
endocarditis associated with the open structure. Over time,
the increased pulmonary blood flow precipitates pulmonary
vascular obstructive disease, which is ultimately fatal. If an
infant has failed to thrive or has overt congestive heart
failure, the ductus should be interrupted, regardless of age
and size.

9. Pictured in the left panel is the Nit-Occlud PDA
occlusion device, with its bi-conical configuration.
The middle and left panels show lateral aortograms
before and after occlusion with the device. (Modified
from Schneider DJ, Moore JW: Patent ductus arteriosus.
Circulation 2006;114:1873–1882).

10. The Amplatzer™ Duct Occluder models. (A) Amplatzer™ Duct
Occluder. (B) Amplatzer™ Duct Occluder II. (C) Amplatzer™ Duct
Occluder II-AS (additional sizes). All images courtesy of Abbott (St.
Jude Medical Inc).

11. AIM OF THE WORK

12. Comparing the feasibility and short-outcomes of trans-
catheter closure of PDA in small infants versus surgical
ligation.

13. PATIENTS AND METHODS

14. PATIENTS AND METHODS
*
This study will include infants with the following inclusion
criteria:
Moderate to large hemodynamically significant PDA
(pulmonary end diameter> 2.5mm) with uncontrolled heart
failure.
Weight less than 5 kg
Age below 6 months.

15. PATIENTS AND METHODS
Patients will be excluded if they :
Have small PDA
Weight more than 5 kg and age more than 6 months
Complex congenital heart disease with PDA dependent
lesions.
PDA combined with other lesions necessitating surgery.

16. PATIENTS AND METHODS
All patients will be subjected to:
Informed consent of the parents will be obtained for all patients.
History taking : personal history, symptoms of heart failure ,past
history of recurrent chest infections or repeated hospital
admission and family history of congenital heart disease.
Full clinical examination; stressing on vital signs ,anthropometric
measures, complete chest and heart examination.

17. PATIENTS AND METHODS
Chest X-ray.
Resting ECG .
Pre-catheterization Transthoracic Doppler echocardiography.
Percutaneous closure of PDA using different devices.
Post closure study by:
a. clinical follow up:
symptoms of heart failure, weight gain, disappearance of
clinical signs of PDA.
b. Transthoracic Doppler Echocardiography :
at day one, one month and six months post intervention for detection of residual
flow and complications .

18. THANK YOU
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