EPIDEMIOLOGY OF PDA

DR. NURE ISHRAT NAZME HMO, MU-1

DHAKA SHISHU HOSPITAL

Patent ductus arterisus is a congenital heart

abnormality wherein ductus arteriosus fails

to close after birth.

As an isolated defect, PDA is the 5th - 6th most

common congenital cardiovascular lesion.

It represents 5-10% of all types of Congenital

Heart Diseases, excluding those in premature

infants.

It occurs in approximately 8 per 1000 live

premature births.

Isolated PDA is found in around 1 in 2000 full

term infants.

A higher prevalence is found in preterm infants.

50–80% incidence was found in preterm infants

<26 wks gestation. Douglas J et al, Circulation. 2006;114:1873-1882.

In babies who are less than 1500 g at birth,

many studies show the incidence of a patent

ductus arteriosus >30%.

The female to male ratio is 2:1.

In patients in whom the PDA is associated

with a specific teratogenic exposure, e.g.

congenital rubella, the incidence is equal

between the sexes.

PDA occurs more commonly in

populations that  live at high altitude.

The incidence is as much as 30 times greater in

populations that live higher than 5000 m.

As many as 20% of neonates with respiratory

distress syndrome have a patent ductus

arteriosus.

Rubella infection during the first trimester of

pregnancy, particularly in the first 4 weeks, is

associated with a high incidence of PDA.

PDA is also associated with-

single-gene mutations

(such as Carpenter’s

syndrome and Holt-

Oram syndrome).

X-linked mutations

(such as incontinentia

pigmenti).

asphyxia at birth.

fetal alcohol syndrome.

maternal amphetamine

use and

maternal phenytoin use.

Occasional cases are associated with specific genetic defects, such as-

Trisomy 21

Trisomy 18

Rubinstein-Taybi syndrome and

CHARGE syndrome.

Familial occurrence of PDA is uncommon.

The usual mechanism of inheritance is

considered to be polygenic with a recurrence

risk of 3%.

In some patients genetic mechanism of PDA

may be autosomal recessive inheritance with

incomplete penetrance.

PDA cases undergo spontaneous closure in a

rate of 0.6% per year.

It is estimated that if left untreated, the mortality

rate is-

-20% by age 20 years.

-45% by age 45 years.

-60% by age 60 years.

Incidence of CHD in Bangladesh: in 80s(Jan’82 – Dec’91)

ASD VSD PDA Others TOF TOF+ TGA Others

Total = 2636

N1245

N888

N162

N341

N446

N448

N9

N3

1500

1250

1000

750

500

250

0

500

400

300

200

100

0

39.88%

28.44%

5.19%

10.92%

14.28%14.35%

0.29%

0.096%

Acyanotic Cyanotic OthersTotal = 3

5

4

3

2

1

0

Note: ASD was the majority,<10 year VSD was highest.Ref.:The Incidence of CHD diagnosed by non-invasive technique-ten years study in Bangladesh

Sufia Rahman et all. DS (Child) HJ Vol8(1992):No1&2

Total = 903

Prof. Manzoor Hussain

PDA

5.19%

Past & Present comparison of CHD at Dhaka Shishu Hospital from Nov. 1989 to Oct. 1990 with that of June, 2007 to Sept, 2009

& June 2007 to Sept.2009.

VSD TOF ASD PDA P/S Others

Nov. 1989 – Oct. 1990

June 2007 – Sept. 2009

19 8 4 3 1 1

52.78%

22.22%

11.11%8.33%

2.78% 2.78%

26.90%

20

15

10

5

0

150

125

100

75

50

25

0

N = 36

Jan’ 2005 – Apr’ 2007

38 114 47 2624

9.09%7.05%

21.15%

8.71%

4.82%4.45%

4 24 3 58

0.74%4.45%

1.29% 0.55%

10.76%

VSD TOF ASD PDA PS TGA DORD A-V TAPVD Si VE M C Others7145 49

N = 537

N = 539

175

150

125

100

75

50

25

0

142 64127 30 22 12

26.44%

11.91%

23.64%

5.58%4.09%

2.23%612 2 2 55

01.11%2.23% 0.37%00.37%

10.24%

63

11.73%

142

VSD ASD PDA TOF TGA P/S A-V DORV HLHS Si VE M. C.Others

Prof. Manzoor HussainCourtesy: Echo lab experience, DSH, Dr. Sayeed

Jan.2005 – Apr.2007

Past & Present comparison of CHD at Dhaka Shishu Hospital from Nov. 1989 to Oct. 1990 with that of Jan, 2005 to Apr, 2007

& June 2007 to Sept.2009.

VSD TOFASD PDA P/S Others

Nov. 1989 – Oct. 1990

June 2007 – Sept. 2009

8 4 3 1 1

52.78%

22.22%

11.11%

8.33%2.78% 2.78%

26.90%150

125

100

75

50

25

0

N = 36

Jan’ 2005 – Apr’ 2007

38 114 47 2624

9.09%7.05%

21.15%

8.71%4.82%

4 24 3 580.74%

4.45%1.29% 0.55%

10.76%

VSD TOFASD PDAPS TGA DORD A

-V TAPVD Si VE M C Others7145 49

N = 537

N = 539

175

150

125

100

75

50

25

0

142 64127 30 22 12

26.44%

11.91%

23.64%

5.58% 4.09%

2.23%612 2 2 55

01.11%2.23% 0.37%00.37%

10.24%

63

11.73%

142

VSD ASD PDA TOF TGA P/S A-V DORV HLHS Si VE M. C.Others

Manzoor HussainCourtesy: Echo lab experience, DSH, Dr. Sayeed

Reference

1.Nelson text book of pediatrics-18th edition.

2.Professional guide to disease-8th edition.

3.Pediatric cardiology-2nd edition by Benson LN .

4.The 5 minutes Pediatric consult,2008.

5. Forsey et al Orphanet journal of rare diseases, 2009,4:17,1172-74

6. Douglas J et al, Circulation. 2006;114:1873-1882