first research done on PDA closure in Kurdistan and Iraq

1. 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 asofaek@hotmail.com

2. 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

3. 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.

5. 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.

6. Balloon occlusion test before closure Snaring from arterial side
Embolization

7. 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)

8. AMPLATZER DEVICE SIZE PATIENT %
NUMBER
5/4 20 7.6
6/4 74 28.03
8/6 92 34.84
10/8 42 15.9
12/10 24 9.1
14/12 8 3.03
16/14 4 1.5
TOTAL 264

9. Immediate Angiographic flow after closure with the device
• Complete closure 62.5%
• Foaming 32.1%
• Residual shunt 5.3%

10. Causes of not doing closure ( 20 cases )

11. 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.

12. • 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):513–9
2
Bilkis et al.,the amplatzer duct occlude : experience in 209 patients , JACC,2001; 37( 1).

13. • 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

14.  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 3
Pass et al., USA Amplatzer PDA Occlusion Device Trial, JACC, 2001; 44
3
4
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 – 104
5
Thanopoulos et al., PDA Closure with the Amplatzer Duct Occluder, JACC, 2000; 35(4):1016–21

15. 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

16. 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

17. Happy new Year ( NAWROZ ) for Kurdish People
1.1.2713
and also for all Persian and Aryan people in west
Asia