CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 6, July 2013
204
AFRICA
one additional patient by one month’s follow up. Two patients
had residual PDA by three months and these patients were lost to
follow up, therefore achieving a closure rate of 94.44% by three
months’ follow up.
There were two patients with other congenital heart defects.
One patient had a single ventricle, common atrium, pulmonary
artery (PA) band, Glenn shunt and stenosis at the origin of the left
and right pulmonary arteries due to the PA band. The patient had
percutaneous PDA closure and right pulmonary artery-to-left
pulmonary artery stenting. This patient had the longest screening
time (88 minutes) as there were complications associated with
the stenting of the branch pulmonary arteries. The second patient
had an atrioventricular septal defect with a tiny inlet ventricular
septal defect and a primum atrial septal defect, which would be
attended to at a later stage.
When reviewing complications or outcomes; in one patient
the device embolised to the left pulmonary artery following
release. This device was successfully retrieved and the patient
was sent for surgical closure of the PDA (Fig. 3). In another
patient, there was mild left pulmonary artery (LPA) stenosis
with a gradient of 15 mmHg. This gradient had not worsened on
follow up. There were no other complications reported.
Discussion
Percutaneous closure of symptomatic PDA has become the
preferred method over surgical closure. For moderate to large (
>
3 mm) PDAs, the Amplatzer duct occludder type I has been the
device of choice.
15
However, there are limitations in using the
ADO I device. The device is made of polyester material, which
TABLE 3.ANGIOGRAPHIC DATA, CLOSURE
APPROACHAND OUTCOMES
Pat-
ients
PDA
type
Narr-
owest
diam-
eter
PDA
amp-
ulla
PDA
length
Radi-
ation
expo-
sure
Mode of
delivery
Closure
device
Outcome
1 A 3.6 7.4 5.6 22.4 Pulmonary 05 × 06 Immediate closure
2 A 0.6 7.8 15.3 18 Aortic 03 × 06 Immediate closure
3 A 2.2 4.78 4.08 10.21 Pulmonary 03 × 06 Closed in one month
4 A 2 10.5 8.4 17.5 Pulmonary 04 × 06 Closed on day one
5 C 2.8 4.2 6.4 21.8 Pulmonary 06 × 06 Closed on day one
6 E 1.65 6.96 7.85 21 Pulmonary 03 × 06 Lost to follow up
7 D 2 7.1 10.9 25.2 Pulmonary 06 × 06 Immediate closure
8 A 0.9 8.2 8.9 15.3 Pulmonary 03 × 06 Closed on day one
9 E 2.2 6.5 8.6 24.3 Pulmonary 04 × 06 Closed on day one
10 C 3.6 4.3 10 15.2 Pulmonary 05 × 06 Immediate closure
11 E 3.4 12.6 13.5 17.5 Pulmonary 06 × 06 Immediate closure
12 E 2.1 8.9 11.8 13.6 Pulmonary 06 × 06 Closed on day one
13 A 3 11.1 9.7 21.6 Pulmonary 06 × 06 Closed in one month
14 A 1.4 10.8 16.6 23.2 Aortic 05 × 06 Immediate closure
15 C 5.5 13.7 10.1 29.4 Pulmonary 06 × 06 Embolised, surgery
16 B 4 4.8 3.3 28.8 Pulmonary 04 × 06 Lost to follow up
17 A 2.1 12 9.2 17.5 Pulmonary 04 × 06 Closed on day one
18 A 2 12 7.4 42.1 Aortic 03 × 06 Immediate closure
19 E 4.2 15.1 14.9 14.8 Pulmonary 06 × 06 Immediate closure
20 E 3.3 17.7 17.3 7.1 Pulmonary 04 × 06 Closed on day one
21 C 1 5 8 79.21 Aortic 03 × 06 Immediate Closure
22 E 2.2 10 9.3 23.3 Pulmonary 06 × 06 Immediate Closure
23 E 1.8 5.6 11.5 88.7 Aortic 06 × 06 Immediate Closure
24 B 4 4.9 3.4 13.8 Pulmonary 04 × 04 Immediate Closure
25 D 3.5 11.8 14.5 8.5 Pulmonary 06 × 06 Immediate Closure
26 B 3 3 2.5 17 Pulmonary 04 × 04 Immediate Closure
27 A 1.86 12.56 6.07 11.1 Pulmonary 03 × 06 Closed on day one
28 A 4.5 14.6 12.7 21.2 Pulmonary 06 × 06 Immediate Closure
29 A 2.5 15.8 14.8 23.2 Pulmonary 06 × 06 Immediate closure
30 C 3.3 7.5 15.1 14.1 Pulmonary 04 × 06 Immediate closure
31 B 4.9 7.3 3.8 30.7 Pulmonary 06 × 04 Immediate closure
32 A 1.8 8.6 7.6 9.7 Pulmonary 03 × 06 Immediate closure
33 A 1.3 18.7 6 13.3 Pulmonary 04 × 06 Immediate closure
34 A 6.2 15.4 15.6 31.5 Aortic 06 × 06 Immediate closure
35 E 3.5 8.2 6.3 19.4 Pulmonary 05 × 06 Closed on day one
36 A 0.8 5.3 6 24.9 Pulmonary 03 × 06 Immediate closure
Mean
2.74 9.46 9.5
TABLE 2. PATIENT BASIC CHARACTERISTICSAND
HAEMODYNAMIC DATA
Patients
Age
(months)
Weight
(kg)
Height
(cm) Gender Qp:Qs
Rp
(WU)
PA
systolic
(mmHg)
Mean
PA
(mmHg)
1
18 7.6 74 M 2.68 2.77 46
31
2
9
6.4 65
F 1.18 0.789 18
9
3
5
8.1 76
F 1.5 1.4 34
27
4
47 18.7 99.5 F 1.31 1.41 27
22
5
5 3.94 58 M 8.72 0.59 43
31
6
6
5.3 62
F 3.47 0.51 30
17
7
48 18.3 103 M 1.38 0.54 28
20
8
5
4.7 64 M 1.48 2.47 23
12
9
5
5.1 62 M 1.82 2.75 28
20
10
6 4.88 55.5 M 1.08 4.59 40
29
11
3
5.9 55 M 1.57 1.7 20
16
12
8
5.2 56
F 1.18 3.84 32
24
13
38 11.1 91
F 1.72 1.5 31
27
14
19 12.4 83 M 2.2 1.8 38
26
15
9
6 62
F 2.8 2.02 57
48
16
8
5.7 63 M 1.21 1.96 38
27
17
54 22.5 107.5 M 1.34 0.27 26
19
18
73 17.2 109 M 1.29 1.95 31
18
19
39
13 92.3 F 3.34 1.37 31
17
20
80 20.3 117 F 1.74 0.1 18
15
21
81
20 112 F 1.1 0.74 20
17
22
35 14.2 91.5 M 1.04 1.17 24
17
23
40 12.4 94
F 1.46 1.12 75
23
24
9
7.9 61
F 3.54 4.46 78
61
25
42 11.9 101 F 2.48 1.25 29
22
26
7 4.48 68
F 1.62 3.19 48
36
27
28 13.9 85
F 1.4 0.56 21
14
28
4
4.3 59 M 1.8 2.96 36
29
29 233 59 166 F 1.56 1.39 24
18
30
7
5.2 67
F 1.2 5.53 44
31
31
3
4.6 56 M 9.65 2.69 31
23
32
47 14.9 103 F 1.13 1.13 19
16
33 156 39.2 152 F 1.1 0.71 23
16
34 190 63 158 F 1.46 2.8 47
37
35
2
3.9 56
F 1.5 1.96 40
26
36
15 5.9 73 M 5.95 1.47 55
38
Mean
2.25 1.87 34.80 24.4
QP:QS, pulmonary blood flow:systemic blood flow ratio; RP (WU), pulmo-
nary resistance in Wood units; PA systolic, pulmonary artery systolic pres-
sure; Mean PA, mean pulmonary artery pressure.
