Patent Ductus Arteriosus Device or Surgical Closure: the Role of Charity Missions Where the Resources Are Limited

Objectives: To compare the different methods of treatment of patent ductus arteriosus (PDA), and evaluate the role of charity missions in availing the expensive devices for needy patients where the resources are limited.Background: The role of surgery is gradually being taken over by catheter intervention, however the cost in not affordable to most of our patients. Charity organizations are helping limited resource countries by availing the devices.Methods: All paediatrics patent ductus arteriosus (PDA) patients presenting to Medani Heart Centre (MHC) in a 6-year period were included in this study. The study included 337 patients. 283 were treated by catheter intervention group (A) and 54 were treated surgically group (B), 22 patients were referred for surgery from the catheterization laboratory, and 32 were treated when there was no visiting teams.Results: A total of 337 patients were included in this study, 32 were treated surgically by the local surgical teams. Out of remaining 305 patients 283 were found suitable for catheterization intervention, and were treated successfully, 22(%7) were having other congenital anomalies or PDA not suitable for intervention and were referred to surgery. 54 patients were treated by surgical ligation, 22 were referred from the intervention group and 32 were treated surgically when there were no visiting delegates and patients’ condition dictate urgent intervention, with good results. Devices were provided by charity organizations and delivered by the visiting teams, the choice of device depends on the availability.Conclusions: Surgery remains a good modality of treatment were the resources are scares, however a number of charity organizations are offering these expensive devices for countries of low and middle income making it possible for the poor patients to have such treatment. The results of both treatments are excellent

Patent Ductus Arteriosus Device or Surgical Closure: the Role of Charity Missions Where the Resources Are Limited

Objectives To compare the different methods of treatment of patent ductus arteriosus (PDA), and evaluate the role of charity missions in availing the expensive devices for needy patients where the resources are limited. Background The role of surgery is gradually being taken over by catheter intervention, however the cost in not affordable to most of our patients. Charity organizations are helping limited resource countries by availing the devices. Methods All paediatrics patent ductus arteriosus (PDA) patients presenting to Medani Heart Centre (MHC) in a 6-year period were included in this study. The study included 337 patients. 283 were treated by catheter intervention group (A) and 54 were treated surgically group (B), 22 patients were referred for surgery from the catheterization laboratory, and 32 were treated when there was no visiting teams. Results A total of 337 patients were included in this study, 32 were treated surgically by the local surgical teams. Out of remaining 305 patients 283 were found suitable for catheterization intervention, and were treated successfully, 22(%7) were having other congenital anomalies or PDA not suitable for intervention and were referred to surgery. 54 patients were treated by surgical ligation, 22 were referred from the intervention group and 32 were treated surgically when there were no visiting delegates and patients’ condition dictate urgent intervention, with good results. Devices were provided by charity organizations and delivered by the visiting teams, the choice of device depends on the availability. Conclusions Surgery remains a good modality of treatment were the resources are scares, however a number of charity organizations are offering these expensive devices for countries of low and middle income making it possible for the poor patients to have such treatment. The results of both treatments are excellent

Risk factors associated with post-transplant superior caval vein stenosis in paediatric heart transplantation

Superior caval vein stenosis is a known complication following paediatric heart transplantation. Herein, we sought to assess the incidence of superior caval vein stenosis and need for intervention in a single centre paediatric heart transplantation programme. A retrospective review was performed to identify variables associated with superior caval vein stenosis and need for intervention. Patients were identified based on angiographic and echocardiographic signs of superior caval vein stenosis. Of 204 paediatric heart transplantation recipients, 49 (24.0%) had evidence of superior caval vein stenosis with no need for catheter intervention and 12 (5.9%) had superior caval vein stenosis requiring catheter intervention. Overall, patients with superior caval vein stenosis with and without intervention had more cavopulmonary anastomosis (41.7%; 20.4%), pre-transplant superior caval vein procedures (41.7%; 28.6%), and bicaval approach (100.0%; 98.0%), compared to the group with no stenosis (11.9% and p = 0.015, 12.6% and p = 0.004, 73.4% and p < 0.001, respectively). Smaller recipients and donors were more likely to need intervention. Intervention was also seen more frequently in recipients who were younger at diagnosis (4.7 years) compared to non-intervention (13.3 years; p = 0.040). Re-intervention was required in 16.7% patients (n = 2) and was not associated with any complications.

Transcatheter Intervention for Coarctation of Aorta: Current Status

Coarctation of aorta (CoA) is an important, treatable cause of heart failure in neonates and of secondary hypertension in adolescents and adults. Surgery has remained as the gold standard in neonates but catheter intervention has usurped it in children, adolescents, and adults. Introduction of covered stents has made the intervention safer. Since it usually appears to be a discrete lesion, at first glance, it attracts interventional cardiologists. However, CoA intervention is associated with significant immediate and long-term complications. Thus, it is imperative for the interventionist to understand the minutiae of the intervention, how to perform it correctly, and how to minimize complications. This review aims to provide complete description of intervention in neonates, adolescents, and adults in one place and also to guide interventional cardiologists perform safer intervention especially in subatretic and atretic CoA.