Natural History & Clinical Outcomes of Patients with Patent Ductus Arteriosus at Sunpasitthiprasong Hospital
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Abstract
Background: Patent ductus arteriosus(PDA) is one of the most common congenital heart diseases (CHDs) found in children. However, its natural history, treatment, and outcomes have not been previously studied at Sunpasitthiprasong Hospital.
Objective: To study patients diagnosed with isolated PDA for the first time before 15 years of age.
Methods: A retrospective descriptive study was conducted by collecting and analyzing the medical records of patients diagnosed with isolated PDA in the pediatric cardiology clinic from January 1st, 2005, to December 31st, 2014.
Results: In this study, 384 patients were enrolled. The median age of diagnosis was 30 days (range: 1-5,232). Among the participants, 227 patients(59.1%) were female. We identified an associated chromosomal abnormality in 60 cases(15.6%), the majority of which were associated with Down syndrome(96.7%). Clinical congestive heart failure was present in 211 patients(54.9%). Regarding the modes of management, duct closure was achieved through catheter-based procedures in 70.3% of cases, while surgical intervention was utilized in 29.7% of patients, totaling 148 individuals .The successful occlusion rate was 96.7%, with only 5 patients (3.3%) requiring a second closure, none of whom experienced serious complications. Patients who experienced spontaneous closure accounted for 37.2% of cases, with a median age of 220 days(range: 30-6,589). Additionally, a significant association was observed between a PDA size of ≤3 mm(in comparison to sizes >3 mm) and spontaneous closure, exhibiting an unadjusted odds ratio(95% CI) of 5(2.05-12.49).
Conclusion: In the natural history of PDA, spontaneous closure was observed in 37.2% of cases, particularly associated with a mean PDA size smaller than that in the clinical follow-up group. A PDA size of ≤3 mm could serve as a predictor for subsequent spontaneous closure, displaying an odds ratio of 5. The choice of management modalities relies on clinical manifestations. If duct closure becomes necessary, the decision-making process for surgical or catheter-based intervention depends on several factors including PDA type, age, body size, clinical status, and parental acceptance. Both procedures demonstrated good outcomes and a high occlusion rate without serious complications.
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