Background: Standard medical treatments for patent ductus arteriosus (PDA) closure are, including indomethacin/ibuprofen and surgical ligation. Nowadays, a new strategy to close PDA is the use of paracetamol. The present study aimed to describe the use of intravenous (IV) paracetamol for PDA closure in neonates who present a contraindication to ibuprofen or ibuprofen failure with no possibility to perform surgical ligation due to major instability. Methods: The present study was conducted from January to December 2017 in the neonatal intensive care unit of Dr. Zainoel Abidin Hospital and Harapan Bunda Hospital, Banda Aceh, Indonesia, on neonates with hemodynamic significant PDA (hsPDA). All the subjects received IV paracetamol (15 mg/kg every 6 h) for 3 days. Thereafter, the ductus was evaluated by echocardiography on the 5th day after the regiment. Results: A total of 72 neonates were diagnosed with hsPDA and their average of gestational age was 34. 26 weeks and their average of birth weight was 1945. 69 g for 39 (54. 2%) female neonates, 33 (45. 8%) male neonates, 45 (62. 5%) premature infants, and 27 (37. 5%) full-term infants. About 26 (36. 1%) infants had a closed PDAs on the 5th days of evaluation, 11 (15. 3%) infants had regiment twice for closed PDA at the 10th days of evaluation, and 35 (48. 6%) neonates had more closed PDA after three or four regiments. Successful closure with paracetamol was achieved in 51(70. 8%) neonates, while 21 (29. 2%) neonates failed the PDA closure. Conclusion: Based on the findings of the present study, IV paracetamol appears to be reasonably effective for PDA closure in both preterm and term infants. This should be the first-line of therapy choice when there are contraindications for the treatment with ibuprofen.

Introduction: Shone syndrome is a rare congenital anomaly consisting of multiple levels of obstruction in the left side of the heart and aorta. In its complete form it comprises four types of lesions: (1) parachute mitral valve; (2) supravalvular ring of left atrium; (3) subaortic stenosis of either the muscular or membranous type; or (4) coarctation of the aorta. Shone complex is rarely associated with patent ductus arteriosus. Only two other cases of such association has previously been reported.Case Presentation: We report an 18 year old male referred to our center for aortic and mitral valve replacement who was a near complete case of Shone syndrome associated with a history of repaired coarctation and patent ductus arteriosus during infancy and subsequently repair of aortic valve at 3 years of age. Now he became symptomatic due to the progression of aortic stenosis and congenital mitral valve stenosis. Echocardiography revealed unicuspid aortic valve with severe stenosis and parachute mitral valve deformity with supravalvular ring resulting in severe mitral stenosis. The patient had undergone aortic and mitral valve replace- ments.Conclusions: This rare case is a near complete form of Shone complex associated with patent ductus arteriosus. It is emphasized that when any form of left heart obstruction is encountered we should meticulously look for other associated lesions.

Objective: Treacher Collins syndrome or mandibulofacial dysostosis is a rare genetic syndrome characterized by a small mandible and ear anomalies. Some of the patients have congenital heart disease. Case report: A 10-months old female infant with micrognathia, bilateral conductive hearing loss needing hearing aid, and patent ductus arteriosus is presented. Chromosomal study yielded normal karyotype and Treacher Collins syndrome was the first diagnosed by the genetician. The ductus was occluded by a pfm coil.Conclusion: In general, patient affected with Treacher Collins syndrome have no mental or skeletal problems and they can be productive members of the society. So diagnosis and treatment of their congenital heart abnormalities has a greater importance in comparison with patients affected by other genetic syndromes.

Background: Transcatheter patent ductus arteriosus (PDA) closure is an established procedure.Objectives: The aim of the study was to assess midterm follow up of the Nit-Occlud coil and the amplatzer ductal occluder (ADO) closure of PDA.Patients and Methods: In this cohort study, we collected the longitudinal data of patients who underwent percutaneous closure using coil or ADO from November 2005 to November 2013. A total of 404 patients with PDA closure by devices were included during the study period. Coil occlusion was performed in 220 patients and 184 patients underwent catheterization using ADO. Follow-up evaluations were performed with echocardiography at two weeks, two months, six months, and during the study period (in average 4.83.8 years).Results: The patients’ mean age was 24 months (range: 1 - 312). The catheterization was successful in 393 (97.2%) patients and unsuccessful in 11 (2.7%). Immediate complete occlusion was seen in 290 (73.7 %) patients. The occlusion rates at two weeks, two months, six months, and during the study period were 73.7%, 84%, 93.6%, 98.7%, and 99.5%, respectively. Complications occurred in 23 (5.8%) patients during or immediately after the catheterization, and device embolization with 2.7% was the most common complication.Most complications occurred in a patient with pulmonary hypertension who was less than one year old and was undergoing the first year of experience with devices.Conclusions: Our findings showed that transcatheter occlusion of the PDA is an effective and safe intervention by coil or Amplatzer with excellent early and one-year outcomes. Pulmonary hypertension, age of less than 12 months and experience of less than one year may increase the complications of device closure.

Background and Aim Patent Ductus Arteriosus (PDA) is a common problem in premature neonates, especially in neonate’, s low birth weight (LBW). This study aimed to compare the effectiveness of oral and intravenous ibuprofen in the management of PDA. Methods & Materials We enrolled 40 low birth weight neonates (gestational age <37 weeks) with PDA into semi-experimental study. the LBW neonates received ibuprofen as an initial dose of 10 mg/kg, followed by 5 mg/kg at 24 and 48 hours later. The exclusion criteria were congenital chromosome anomalies, congenital heart disease, asphyxia, sepsis. The PDA was initially confirmed by echocardiography. Treatment efficacy was evaluated by echocardiography after the treatment. Ethical Considerations This study was approved by the Ethics Committee of Arak University of Medical Sciences (Code: IR. ARAKMU. REC. 1396. 265). Results Of the total participants 37. 5% (female 25) were girls. Gestational age ranges from 29 to 36 weeks. The average birth weight was 1639±, 616 gr and the minimum of weight 750 gr. the mean gestational age was 30. 4±, 4. 0 weeks. After the first dose of ibuprofen, closure of PDA was observed in 32 patients (80%), PDA closed in eight patients (20%) with to repeat course ibuprofen. There was no significant relationship between the frequency of ibuprofen use with gestational age (P=0. 06), birth weight (P=0. 08), type of delivery (P=0. 068) and multiple births (P=0. 061). Conclusion Most LBW neonate with PDA responded to using the first course of ibuprofen. extremely, all LBW infants responded to the second course. it seems that ibuprofen is as effective as ibuprofen for PDA closure even in LBW infants.

Background: The percutaneous transcatheter closure of patent ductus arteriosus (PDA) has been a widely used treatment method. However, PDA device closure in neonates or patients with specific PDA morphology has been difficult due to the protrusion of the device into the descending aorta. The right angle between the disc and plug causes some degree of protrusion of the disc into the descending aorta because normal PDA forms an acute angle with the descending aorta. Objectives: There have been limited data about the angles of PDA since Mancini’, s study in 1951, and new studies are required in this regard. This study measured the angles between PDA and descending aorta through angiography in a beating heart. Methods: Within December 2008 to November 2016, 190 patients undergoing percutaneous PDA occlusion were included in this study. Retrospectively, the mean angle of PDA was measured by three cardiologists between the longitudinal axis of the descending aorta and the longitudinal axis of the PDA through an aortogram. The patients were divided into three groups according to age (group A: under 1, group B: 1-6, and group C: over 6 years of age) and PDA morphology based on Krichenko’, s classification (type A: conical PDA, type B: window PDA, type C: tubular PDA, type D: complex PDA, and type E: elongated PDA). Results: Of 190 study patients, 135 patients were female, and the median age of the patients was 7 years (range: 75 days to 60 years). The mean angle of PDA was 48. 2, 12. 0°, . There were no statistical differences regarding PDA angle among the groups classified by age and PDA morphology. Conclusions: The authors are hopeful that the obtained data will help develop a better device for the percutaneous transcatheter closure of PDA.

Proximity of the vagus nerve to a patent ductus arteriosus (PDA) can cause traction or entrapment of vagus nerve during surgical closure of the in rare occasions. This can lead to a life threatening postoperative bradycardia. Herein, we report a case of bradycardia caused by unexpected irritation of the vagal trunk by the end of operation. The patient was managed by re-opening the chest, lung retraction and removal of mediastinal pleura sutures. The vagal trunk entrapped in the suture line was released immediately. Heart rate accelerated and hemodynamic restored after a short period of observation. The operation terminated as routine, patient extubated in OR and discharged within 24 hours with no further complication. This irritation of vagus results in vagal bradycardia during or by the end of operation. Awareness of a surgeon of this issue can minimize the risks and complications of the open closure of PDA.

Background: Patent Ductus Arteriosus (PDA) is considered one of the most prevalent types of congenital heart disease. The closure of the ductus arteriosus physiologically occurs at the first 48-72 hours after the birth in healthy term infants. Different causes can result in the pathological opening of ductus arteriosus. This study aims to investigate the effect of oral acetaminophen on the closure of PDA in preterm neonates. Methods: The present study is a trial without control. Forty-five preterm neonates with a gestational age of <32 weeks were studied. Acetaminophen was orally administered with a dose of 10mg/kg every 6 hours for three days. Closure of ductus arteriosus was considered as the success of treatment. Data were analyzed using SPSS 15. Data were reported as )frequency-percent) and mean ± SD. To evaluate the normal distribution of data, we used a Kolmogorov-Smirnov test. Statistical significance was defined as P<0. 05. Results: The study population consisted of 20 male and 25 female infants with the mean gestational age of 28. 95 ± 1. 66 weeks. Cesarean-born infants and vaginal-born infants consisted 17. 8% and 82. 2% of the study population, respectively. The proportion of PDA closure after administration of oral acetaminophen was 82. 3%. Conclusion: The current study indicates that oral acetaminophen is highly effective in closing PDA. Considering its trivial side effects, it has the potency to be a convenient option for treating this condition.