Original article
Cardiovascular
Modified Extrapleural Ligation of Patent Ductus Arteriosus: A Convenient Surgical Approach in a Developing Country

https://doi.org/10.1016/j.athoracsur.2004.07.035Get rights and content

Background

Minimally invasive surgery for the closure of a large patent ductus arteriosus (PDA) using an extrapleural technique offers an alternative to other minimally invasive approaches such as video-assisted thoracoscopic surgery or interventional cardiologic procedures.

Methods

Between August 1999 and December 2003, 513 patients with PDA were admitted to Unidad de Cirugia Cardiovascular de Guatemala, of whom 327 (64%) were considered surgical candidates. Of these, 218 (67%) were selected for surgical extrapleural (SEP) closure initially by weight (< 10 kg) and a ductal diameter at the pulmonary end of greater than 4 mm. Subsequently, we included also patients who weighed more than 10 kg. Median age at operation was 51 months (range 5 days to 38 years).

Results

Median operating time was 32 minutes (range 23 to 52 minutes). All 218 patients had SEP closure and were extubated in the operating room. There were no hospital deaths. Two patients required a blood transfusion. Two additional patients bled postoperatively, requiring reoperation. A pneumothorax occurred in 3 patients that required a chest tube. The 6-month follow-up revealed residual ductal shunts in 2 patients that were closed percutaneously with a coil. The treatment of the remaining 295 patients included a surgical transpleural (STP) approach in 109 (37%) and transcatheter closure in 186 (63%), with a coil in 110 (37%) and an Amplatzer device in 76 (26%).

Conclusions

Minimally invasive closure of a PDA through a short, 3-cm to 5-cm skin and muscle-sparing posterior thoracotomy and an SEP approach provides a convenient and safe technique with a low incidence of complications and also a cost-saving option compared with other invasive techniques.

Section snippets

Material and Methods

Between August 1999 and December 2003, 513 patients (353 females and 160 males) with an isolated PDA were referred to Unidad de Cirugia Cardiovascular de Guatemala (UNICAR) for closure. Median age at operation was 51 months (range 5 days to 38 years) and the median weight was 8 kg (range 1 to 52 kilograms). Excluded from this series were patients with associated cardiac lesions that required additional intracardiac surgery. Echocardiographic diagnosis, with cross-sectional and color-Doppler

Results

Minimally invasive surgical thorocotomy with a SEP approach was accomplished in all of the 218 patients selected for this technique. Median operating time was 32 minutes (range 23 to 52 minutes).

Two patients bled during the operation (0.9%) and required a blood transfusion. Two other patients bled postoperatively, which necessitated surgical evacuation of an extrapleural hematoma. Three patients (1.4%) developed a pneumothorax and required a chest tube. All 7 patients with the described

Comment

Efforts at seeking a low-risk and secure therapeutic outcome for PDA closure, combined with cosmetic and cost-effective results, stimulated the development of alternative treatments such as minimally invasive surgical approaches, percutaneous interventional, and also video-assisted thoracoscopic techniques.

The described minimally invasive SEP operation avoided some, albeit uncommon, late complications reported after a conventional STP technique such as scoliosis, a winged scapula, chest wall

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