Original articleCardiovascularModified Extrapleural Ligation of Patent Ductus Arteriosus: A Convenient Surgical Approach in a Developing Country
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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Surgical management of patent ductus arteriosus in the very preterm infant and postligation cardiac compromise
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2006, Annals of Thoracic SurgeryMuscle-sparing extrapleural approach for the repair of aortic coarctation
2006, Annals of Thoracic SurgeryCitation Excerpt :The exposure of the aortic isthmus is good, and it resembles the one obtained in a retroperitoneal approach to the abdominal aorta, in which the viscera are held en bloc out of the field in the peritoneum. Use of an extrapleural approach to reach the aortic isthmus, however, is not new [17–19], but appears to be underutilized. As most of the coarctation repairs are performed in infancy when the pleura is free from episodes of pleural inflammation, peeling off the parietal pleura from the bony cage never proves difficult.