Some clinical and surgical aspects of patent Ductus arteriosus as seen at Kenyatta National Hospital

Abstract

Patent ductus arteriosus (PDA) is one of the commonest congenital anomalies in infancy. Incidences of PDA together with other congenital anomalies have not yet been worked out for Kenya. This study presents a review of 144 patients operated on for PDA between May 1983 to June 1988 - a five year period.

There was a female predominance over males with a ratio of 2.2:1. A review of all thoracotomy operations done in the five year period shows that PDA operations account for 30.3%.

At birth, under one year and under two years of age, symp­ toms wer~ present in 27%, 55% and 76% of all the patients respectively. The oldest age at on~et of symptoms was 26 years. The youngest operated patients are 4 months old whereas the oldest is 40 years old. Mean ages at onset of symptoms was 2.4 years and that at operation was 6.2 years, which means that a patient has averagely to wait for 3.8 years before operation.

A review of sibling position at birth showed that 1st born babies (30%) were prone to be born with PDA followed by 2nd born babies (17%) and 3rd to rn babies (12%).

Blood groups comparison of study and that of Kenyan African Donors revealed a statistical difference mainly in blood groups A and B; a reflection of a genetic pattern.

Maternal illness review of mothers giving birth to PDA babies was carried out and revealed some sickness and medication during pregnancy in 11.8% of the mothers, but these do not fall in the stigmatised groups of illness predisposing to PDA.

Review of altitudes of places of birth of PDA babies in

Nairobi at (5327ft), Eldoret at (6836ft) and Nakuru at (6200ft) score the top three positions in that order. Between 3700ft altitude and the coast, no PDA case was reported. The commonest clinical presentation was recurrent chest infection (23.6%) followed by palpita­ tions chest infection (21.5%) and palpitations only (18.6%). Other associated elilmic~, features were present in 41.7% of the patients. Other concurrent diseases were pr-esent in 17.6% of the patients.

Ligation emerged as the most popular mode of surgical treatment accounting for 9806% of the PDA operations. Intraoperative findings mainly consisted of anomaly of the great vessels and lung adhesions. Five' patients had the operation cancelled due to technical problems encountered.

Intraoperative complications were properly managed. Com­ parison of patients managed with or without a chest tube revealed that in the two groups, approximately 25% of each would have post operative complications.

Clinical diagnosis alone made accurate diagnosis of PDA in 54.~ of the patients whereas clinical and Echocardio­ graphy was in 26.6% of the patients. It shows therefore, that both clinical'and ECHO diagnosis was done in 7708% of the patients.

Assessment of the outcome of surgery in relation to medical treatment was made. 93% of the patients :showed significant improvement of the clinical symptoms after surgical treat­ ment and did not require further medical support. However, in the remaining 6.9% of the patients no improvement was seen after surgery. Residual murmurs persisted in 12.5% of the patients. It is likely that the residual murmurs could have been caused by another pathology. No follow-up investigations were available during this study.

Five pairs of twins were reviewed in the study where FDA was seen in the two first born twins and three in the secoJ1.dborn twins.

Operative mortality rate of 1.4% was registered in the study and the main cause of death was severe bradycardia