Title:  Anaesthesia for paediatric cardiac catheterization (CC) for closure of patent ductus arteriosus (PDA): 10 years experience.

Background and Goal of Study: In the past 20 years transcatheter closure has become a leading approach for closure of most PDAs. Frequently anaesthesia needs to be provided, especially in paediatric patients1. The aim of this review is to present a data from 10 years of experience of a single centre where paediatric CC is a standard procedure. 
Materials and Methods: A retrospective analysis was performed using the data collected from patients submitted to PDA closure between 2006 and 2016. 
Results and Discussion: 218 interventions were analysed (20,47% of all CC performed), 165 successful (75,7%), 47 only diagnostic (21,6%) and 6 unsuccessful (2,7%). 96,0% were elective, 4,0% were urgent. In the studied group 128 patients were females (58,7%), 90 males (41,3%); 5 were aged < 1 month (2,3%), 43 were 1month-1 year old (19,7%), 134 1-8 years old (61,5%), 29 8-13 years (13,3%) and 7 > 13 years (3,2%). Most patients were classified as ASA I (n=101, 46,3%) or II (n=94, 43,1%, 22 were ASA III (10,1%) and 1 ASA IV (0,5%).  Most frequent comorbidities were: other congenital heart disease, development delay, Down syndrome, cardiac insufficiency and pulmonary hypertension. In most cases general anaesthesia (GA) was provided (n=211; 96,8%), 7 patients were sedated (3,2%). Tiopenthal was mostly chosen for the induction of anaesthesia (n=193; 88,5%), followed by Sevoflurane (n=16; 7,3%). Average duration of the procedure was 87,37min. Most patients went to Post-Anaesthesia Care Unit followed by admission to a general ward, 11 were admitted to Intensive Care Unit (5,0%). During 10 years we observed 23 major complications in 16 patients (7,34%), most frequent were arrhythmia (n=6) and severe hypotension with the need for inotropes/vasopressors (n=7), followed by coil migration (n=4), bronchospasm (n=2) and respiratory depression (n=3). We did not have any mortality case during the study.  
Conclusions: In our centre CC for PDA closure is mostly performed in children aged 1-8y, without other comorbidities or with mild disease without substantive functional limitations, and GA is preferred. The intervention shows to be associated with some major complications with the overall incidence similar to the data present in the literature2.
References:
1.	Alban-Elouen Baruteaua, Sébastien Hascoëtc, Julien Baruteaud, Younes Boudjemlinee, Virginie Lamberta, Claude-Yves Angela, Emre Bellia, Jérôme Petita, Robert Pass. Transcatheter closure of patent ductus arteriosus: Past, present and future. Archives of Cardiovascular Disease (2014) 107, 122—132 
2.	Ko Eun Lee, Yeon Jeong Seo, Gi Beom Kim, Hyo Soon An, Young Hwan Song, Bo Sang Kwon, Eun Jung Bae and Chung Il Noh. Complications of Cardiac Catheterization in Structural Heart Disease. Korean Circ J 2016;46(2): 246-255