Pda Part 2 Epidemiology
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Transcript of Pda Part 2 Epidemiology
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