Asif-ur Rehman, Amna Qurashi, Ahsan Beg, Asma Chaduary.
Inhospital outcome of patent ductus arteriosus device occlusion in the adolescent & adult population.
J Cardiovascular Dis Jan ;16(3):84-8.

BACKGROUND: Patent ductus arteriosus (PDA) in adults is different compared to children in many ways. Although the indications of closures are almost same in all age groups but can have long impact like many patients can turn into Eisenmenger syndrome if not treated. Device closure is safe and prevents such complications when treated early. OBJECTIVE: This study was conducted to see the outcome of device occlusion in adult patients presented with PDA. MATERIAL AND METHODS: We conducted a retrospective study in a tertiary care referral centre. All adult patients with PDA were included. These were patient who presented with PDA and were attempted to close percutaneously. Clinically Eisenmenger due to PDA were excluded. Patients having near systemic pulmonary artery (PA) pressure were balloon occluded, before occlusion. Results: A total of 109 patients underwent for PDA device occlusion from October 2010 to December 2019. Females were 85.3% (n=93) and 14.7% (n=16) were male. The age ranged from 16 to 60 years (mean age 24.5 ? 10 years). Endocarditis was present in 8 patients at first presentation and 1 patient presented in the postpartum period. Occlusion was successful in 95.4% (n=104) and 5 were abandoned (3 due to irreversible pulmonary hypertension and 2 due to non-availability of appropriate sized device). There was no pulmonary hypertension (mPAP<25mmHg) in 34% (n=37); mild pulmonary hypertension (mPAP=25-40mmHg) in 50% (n=55); moderate pulmonary hypertension (mPAP=41-55mmHg) 4 % (n=4) and severe pulmonary hypertension (mPAP>55mmHg) 12 % (n=13). The narrowest point of PDA on angiography ranged from 3 to 15mm (mean 5.72mm ?2.53mm). Duct occluder1 was used in 85.5 % (n=89) and 9.6 %( n=10) required reverse shank occluder to occlude the duct, 1 required muscular VSD device, ASD device was used in 1 patient and in 3 patients post infarction VSD device. The size of the device compared to narrow point was bigger by 2-8mm (mean 4.3 ?1.3mm). There was no reported device embolization in our study. CONCLUSION: Device closure is possible in almost all patients, as different types and bigger devices can be used. In this study we found that a considerably bigger size can be safely taken in adolescents and adult age group which appears to be safer with minimal risk of complications.

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