Masood Sadiq, Zubair Akram, Ahsan W Rathore, Farhan Latif, Asif Ur Rehman.
Risk of Infective Endarteritis in Patent Ductus Arteriosus is closure in all PDA`S justified.
Pak Paed J Jan ;27(3):101-7.

Background:- Once a serious complication, infective endocarditis has become extremely uncommon in patients with persistent ductus arteriosus. Early diagnosis and closure irrespective of the size of duct, has essentially made it an unheard entity in the West. The only indication of closure of a small PDA being prevention of infective endarteritis, however, is often debated. Objective:- To report our experience of infective endarteritis in PDA in an ongoing study on infective endocarditis, evaluating its incidence, clinical pattern and to determine outcome. Setting:- A tertiary referral center for paediatric and adult cardiology. Patients and methods:- In an ongoing study of infective endarteritis in children admitted to a single center, all children with infective endocarditis on PDA from April 1997 to March 2003 were analysed. The diagnosis was based on Duke`s criteria, which proposed two major and six minor criteria. Minor criteria were expanded to include raised acute phase reactants and presence of newly diagnosed or increasing splenomegaly. PDA was classified as small, moderate and large by standard methods. Results:- Of 2908 hospital admissions, PDA was the major underlying lesion in 368 patients (12.6%). Of all hospital admissions, 96 fulfilled the diagnostic criteria for infective endocarditis. Of these, PDA was the underlying lesion in 14 patients (14.6%). The mean age was 8.9 ± 4 years with only one patient under one year of age. Seven patients had small while 5 had moderate and two large PDA. Blood cultures were positive in 6 pts (43%) while vegetations on echocardiography were present in 12 patients (86%). The duration of treatment was 4-6 weeks in all but one patient, who needed 10 weeks antibiotics. Surgery for infective endarteritis was not required in any patient. Thirteen patients had subsequent uneventful closure, 8 by occlusion devices (Coils, Amplatzer device and Rashkind`s umbrella) and 5 by surgical ligation without cardiopulmonary bypass. Conclusions:- The incidence of infective endarteritis on PDA is 4.8/1000 hospital admissions in a tertiary paediatric cardiology referral center. Majority

PakMediNet -Pakistan's largest Database of Pakistani Medical Journals - http://www.pakmedinet.com