Patent Ductus Arteriosus from Diagnosis to Surgical Closure: 10 Years Experience at Federal Medical Centre Abeokuta, Ogun State, Nigeria

Introduction: Patent ductus arteriosus is a common congenital heart defect. PDA accounts for 10% - 22% of CHD in various studies conducted in Nigeria. The addition of the paediatric cardiology sub-specialty unit at Federal Medical Centre Abeokuta was in 2013, and the centre began surgical PDA ligation in 2019. The general aim is to describe the prevalence, demographics and 10-year trend of PDA cases and our experience as a recent provider of surgical PDA ligation. The study set out to describe the prevalence, demographics and 10-year trend of PDA as seen at Federal Medical Centre, Abeokuta from January 2013 to December 2022 and also to describe the demographics and outcomes of patients who had PDA surgical closure from December 2019 to Dec 2022. Materials and Methods: This is an analytical cross-sectional study. Data was prospectively collected from all consecutive cases of Patent ductus arteriosus diagnosed by echocardiography in children aged 3 months to 15, between January 2013 and December 2022. Echocardiogram report was the main study instrument. All echocardiography was performed by the pediatric cardiologist using GE Vivid IQ and GE Vivid E95 with a probe frequency of 2.4 - 8.0 mHz. This machine has standard 2D echocardiography, Doppler and M-mode functions. Data was analysed using SPSS version 29 and Microsoft Excel. Results: A total of 90,894 patients were seen in all Paediatric units out of which 1065 new patients were evaluated using echocardiography during the period studied. Of these, 76 (8.2%) patients had PDA as a primary cardiac abnormality. Analysis of the trend shows that 5% of the reported PDA cases were seen in the first 2 years (2013-2014), following which the centre has recorded an increase in the number of cases. Hence 51% of the PDA cases were seen in the last 4 years. The mean age at diagnosis was 1.35 years ± 2.60. Females were more commonly affected than males with a male-to-female ratio of 1:1.15. In the study period, 19 (25%) had surgical ligation of PDA. Of these, 12 (63%), were done locally in our centre while 7 (31%) were done elsewhere. The youngest child at the time of surgery in our centre was 5 months old while the oldest was 9 years old. The average weight at surgery was 9.4 kg ± 7.0 and the smallest child by weight weighed 3.2 kg. There was no recorded perioperative mortality. Conclusion: PDA constitutes a significant burden of CHD in this study. Long-term medical treatment of hemodynamically significant PDA with anti-congestive medications can be avoided if more centres have the capacity for PDA closure. Providing holistic care from diagnosis to surgical or device PDA closure should be the goal of more secondary and tertiary centres in Nigeria as a route to scale up comprehensive paediatric cardiac services.