Objectives:Comparison of effectiveness and cost of transcatheter occlusion of patent ductus arteriosus (PDA) with surgical ligation of PDA.Methods:This retrospective comparative study was conducted in the pediatric cardiology department of Ch. Pervaiz Elahi Institute of Cardiology Multan, Pakistan. Data of 250 patients who underwent patent ductus arteriosus (PDA) closure either surgical or trans-catheter closure using SHSMA Occluder having weight >5 kg from April 2012 to October 2015 were included in this study. SPSS version 20 was used for data analysis. Quantitative variables were compared using independent sample t-test. Chi-square test and fishers exact was used for qualitative variables. P-value <0.05 was considered statistically significant.Results:There were one hundred and twenty (120) patients who underwent transcatheter occlusion of PDA using SHSMA occluder (PDA Device Group) and one hundred and thirty (130) patients who underwent surgical ligation of PDA (Surgical Group). Incidence of residual shunting was two (1.5%) in surgical group and 0 (0.0%) in PDA Device group for one month follow up period. There were 4 (3.1%) major complications in surgical group. The rate of blood transfusions were high in surgical group (p-value 0.04). Hospital stay time was significantly less in PDA Device group (P-value <0.001). Total procedural cost was 110695+1054 Pakistani rupees in PDA Device group and 92414+3512 in surgical group (p-value <0.001). The cost of PDA device closure was 16.52% higher than the surgical ligation of PDA. There was no operative mortality.Conclusion:The transcatheter closure of PDA is an effective and less invasive method as compared to the surgical ligation. There is a lower rate of complications and the cost is not much high as compared to surgical PDA ligation.

Convenience Sampling was done. Sample size of 130 cases with ages between 5 to 12 years were selected for the study. Results: Overcrowding was noticed in 61% and 85% in urban and rural areas, respectively. In rural areas, most parents were illiterate; similar status was seen in urban areas (64.4%; 67.1% respectively). 60% and 55 % patients have habit of hand washing in rural and urban patients respectively. Toilet facility is available to 60% and 55.6% in rural and urban patients respectively. Economic status of the family is even worse. Average income per family was only Rs.3800 per month. Conclusion: There is a high prevalence of Rheumatic heart disease (RHD) and acute rheumatic fever (ARF) in Pakistan. Overcrowding, poor hygienic conditions, low socioeconomic status, illiteracy are major risk factors for ARF and RHD in Pakistan. In order to address this alarming situation, platforms like Pakistan Pediatric Cardiac Society and Pakistan Pediatric Association need to be mobilized.

Objectives: To determine the spectrum of pediatric heart disease in a newly established cardiac centre in south Punjab. Study Design: Descriptive Observational Case Series. Setting: Department of Pediatric Cardiology of Cardiac Center Bahawal Victoria Hospital (BVH) Bahawalpur. Period: July 2019 to December 2019. Material & Methods: All consecutive patients of any gender, age range from first day of life to18 years, diagnosed as having heart disease (congenital/ acquired) on Echocardiography were enrolled. Patients of isolated bicuspid aortic valve, premature neonates having PDA or those who already had device or surgical intervention done were excluded from the study. The spectrum of the heart diseases in children was assessed by categorizing them as having acquired, acyanotic and acyanotic heart defects. Results: A total of 624 patients were enrolled in the study on the basis of inclusion criteria. There were 56.7 % male (n=354) while 43.3% were female (n=270) with male to female ratio 1.3:1. Majority of the patients were of infant age group (66%, n=412). Congenital heart disease (CHD) was present in 87% of the patients (n=543) while 13% (n=81) had acquired heart disease (AHD). Acyanotic heart lesions were found in 73.1% of patients while cyanotic congenital heart diseases (CCHD) were 26.9 %. Ventricular septal defect (VSD) was the most common CHD (33%), followed by Atrial Septal defect (14.9%) and Patent ductus arteriosus (13.1%). TOF was the most common CCHD (10.1%) followed by TGA (7.4%). Among AHD, 55.6% were of Rheumatic heart disease (RHD) followed by Cardiomyopathy (27.2), pericardial effusion (8.6%) and infective endocarditis (4.9%). Conclusion: The VSD, ASD, PDA, TOF and TGA remain the most common CHD in descending order while RHD is the most common acquired heart disease in children at our centre.

Two hundred and seventy four (274) results of transcatheter occlusion of PDA performed by pediatric cardiologists. All patients who underwent PDA occlusion regardless of their weight either by ADO device or SHSMA occlude were included for analysis. SPSS V23 was used for data processing. Frequency was calculated for qualitative variables and mean for quantitative ones. Results: The mean age of study participants was 9.57+8.82 years. There was female predominance with 65.7% females and 34.3% males. Regarding severity of PDA, 90 (32.8%) patients were presented with large PDA, 70 (25.5%) with moderately large PDA, 107 (39.1%) with moderate PDA and only 6 (2.2%) were presented with small sized PDA. Classical conical shaped PDA was most common manifestation, diagnosed in 66.8% patients and long ampulla shaped in 70 (25.5%) patients. Regarding complications, device embolization occurred in one patient. Residual PDA in catheterization lab was present in 4 (1.5%) patients. Radial pulse loss occurred in 6 (2.2%) patients for which heparin infusion was started until the pulse became palpable. Blood transfusion was required in 3 (1.1%) patients due to excessive blood loss during the procedure. Mild left pulmonary artery obstruction due to protrusion of pulmonary end of device occurred in 2 (0.7%) patients. Device protrusion into aorta was noted in only 16 (5.8%), in all of these patients there was no aortic flow obstruction. Overall success rate was 99.63%. There was no procedure related mortality. Conclusion: Percutaneous patent ductus arteriosus closure is safe with minimum number of complications. Pulse loss, protrusion o aortic end of device into aorta and residual PDA in cath lab (resolved within 24 hours) are common procedural complications.

Objectives: To determine immediate outcomes and complication rate oftranscatheter closure of patent ductus arteriosus. Study Design: Retrospective analysis.Setting: CPE Institute of cardiology. Period: 2009 to May 2016. Materials and Methods:Two hundred and seventy four (274) results of transcatheter occlusion of PDA performed bypediatric cardiologists. All patients who underwent PDA occlusion regardless of their weighteither by ADO device or SHSMA occlude were included for analysis. SPSS V23 was used fordata processing. Frequency was calculated for qualitative variables and mean for quantitativeones. Results: The mean age of study participants was 9.57+8.82 years. There was femalepredominance with 65.7% females and 34.3% males. Regarding severity of PDA, 90 (32.8%)patients were presented with large PDA, 70 (25.5%) with moderately large PDA, 107 (39.1%)with moderate PDA and only 6 (2.2%) were presented with small sized PDA. Classical conicalshaped PDA was most common manifestation, diagnosed in 66.8% patients and long ampullashaped in 70 (25.5%) patients. Regarding complications, device embolization occurred in onepatient. Residual PDA in catheterization lab was present in 4 (1.5%) patients. Radial pulse lossoccurred in 6 (2.2%) patients for which heparin infusion was started until the pulse becamepalpable. Blood transfusion was required in 3 (1.1%) patients due to excessive blood lossduring the procedure. Mild left pulmonary artery obstruction due to protrusion of pulmonaryend of device occurred in 2 (0.7%) patients. Device protrusion into aorta was noted in only 16(5.8%), in all of these patients there was no aortic flow obstruction. Overall success rate was99.63%. There was no procedure related mortality. Conclusion: Percutaneous patent ductusarteriosus closure is safe with minimum number of complications. Pulse loss, protrusion o aorticend of device into aorta and residual PDA in cath lab (resolved within 24 hours) are commonprocedural complications.