Surgical management of patent ductus arteriosus associated with coarctation of the aorta

Three successful surgical cases of coarctation of the aorta associated with patent ductus arteriosus are presented; representing one of each anatomical type: preductal, juxtaductal and postductal. The additional anomaly of the right subclavian artery arising below the coarctation is also discussed.     

Closure of adult patent ductus arteriosus under cardiopulmonary bypass by using foley balloon catheter

BACKGROUND: The wall of patent ductus arteriosus (PDA) in adults is usually fragile and may be associated with calcification. METHOD: We present a 43-year-old female patient who underwent successful ductal closure operation under cardiopulmonary bypass (CPB) via a transpulmonary route. RESULTS: The operation was uneventful and the patient was discharged from the hospital on the 4th postoperative day. CONCLUSION: Transpulmonary route for the closure of the PDA by using CPB is a safe and acceptable approach in adult patients.     

Surgical management of patent ductus arteriosus in low body weight infants

Between January 1980 and December 1994, seventeen premature infants weighing less than 2500 g underwent surgical management for the isolated patent ductus arteriosus (PDA). Indometacine therapy for closure of PDA was not effective for all these patients. In terms of the body weight at birth, they were divided into two groups; Group I (G-I) consisted of ten patients with birth weight less than 1000 g and Group II (G-II) of seven patients weighing more than 1000 g. The age at operation was 22.1 ± 15.4 days in the G-I and 14.3 ± 11.4 days in the G-II. The ductus was ligated in all patients but one of the G-II, in whom it was divided. There were five (50%) hospital deaths in the G-I and none in the G-II. The causes of death in the G-I were related to necrotizing enterocolitis (NEC) in two and infant respiratory distress syndrome (IRDS), acute renal failure, and broncho-esophagial fistula in each. The age at operation tended to be older in nonsurvivors rather than in survivors in the G-I (28.0 ± 16.8 days vs. 16.2 ± 14.0 days, respectively, but the difference did not reach significance). Before surgery, all patients in the G-I required mechanical ventilator support and nine of them were associated with IRDS. In contrast, only two patients in the G-II needed mechanical ventilation preoperatively. The postoperative period of intubation was also significantly longer in the G-I than in the G-II (51.6 ± 35.2 days vs. 2.2 ± 1.5 days, respectively, p<0.05). In conclusions, the surgery for PDA can be safely performed even in small premature babies weighing less than 1000 g. When the medical therapy for PDA is not effective in the premature patients, the surgical management should be considered as early as possible before their conditions become worse due to such critical complications as NEC, IRDS, and renal failure.     

Surgical management of patent ductus arteriosus. A review of 413 cases

Ligation under controlled hypotension is a simple, quick and effective surgical management of patent ductus arteriosus. In this study 413 cases are reviewed: clinical presentations, cardiac catheterization and operative findings are studied in relation to the surgical procedures. Ligation of the ductus was the treatment of choice in 357 cases irrespective of the age and size of the ductus with only four instances of recanalization which needed religation. Other procedures included division and suture, patch aortoplasty, transaortic patch and transpulmonary closure under profound hypothermia and arrest. There were two deaths and only five major types of morbidities described.     

Surgical treatment of the aged patient with patent ductus arteriosus

A 62-year-old woman with massively calcified patent ductus arteriosus (PDA) associated with severe pulmonary hypertension and bilateral hydronephrosis was successfully operated upon. At first, percutaneous nephrostomy was performed under ultrasonographic guidance. Two weeks later, PDA was repaired under cardiopulmonary (CP) bypass, since its division through a left thoracotomy was considered to be fraught with danger. A Foley's balloon catheter was inserted into the aorta through the ductus after a pulmonary arteriotomy under CP bypass. The ductus was closed simpler and safer with a patch mounted on the catheter, because blood flow from the aorta was well controlled by the inflated balloon catheter.     

动脉导管未闭合并感染性心内膜炎的外科治疗

目的总结动脉导管未闭(PDA)合并感染性心内膜炎(IE)外科诊疗的经验。方法32例患者术前均行超声心动图检查(UCG),均在体外循环下进行畸形矫正和赘生物清除。其中18例单纯PDA采用直视缝合法,同期行主动脉瓣置换术6例、室缺修补术和房缺修补术各4例。结果UCG发现赘生物27例,阳性率84.4%,术后病检证实IE改变。1例急诊行PDA直视缝合术及主动脉瓣置换术患者术后因顽固低心排死亡,其余患者均痊愈出院。随访4～152个月,无晚期死亡和IE复发。结论UCG在诊断中有重要作用,正确把握手术时机对治疗效果至关重要。     

Operative management of the calcified patent ductus arteriosus

A technique in which the calcified adult patent ductus arteriosus can be safely divided using a left-sided thoracotomy approach without the need for transient aortic cross-clamping or cardiopulmonary bypass is described. Concentric, nested vascular clamps are placed on the noncalcified pulmonary artery side of the ductus, so that dissection and clamping of the heavily calcified ductus-aortic junction are unnecessary. The pulmonary artery rim surrounding the insertion of the ductus can be divided between the two clamps and oversewn.     

Surgical closure of patent ductus arteriosus outside the operating theater

The widespread availability of newborn centers and competent management of respiratory problems in the newborn have allowed survival of many infants with patent ductus arteriosus (PDA) who previously would have died.Most deaths after surgical correction of PDA in the newborn have been due to problems in management of ventilation and nursing care. Since most patients are intubated and on respirators prior to election of operative closure, we decided to close the ductus in the newborn center, without moving the patient or disturbing the equipment. The same nurses and pediatric fellows would manage the infant after surgery.The first 9 consecutive premature infants with near-fatal respiratory problems associated with patent ductus arteriosus and operated upon in the newborn center all survived, improved, and were discharged home. There were no infections or other major surgical complications. We conclude that, in properly selected patients, surgical closure of the patent ductus arteriosus is best done in the newborn center under local anesthesia.     

Surgical treatment of patent ductus arteriosus in extremely premature infants

During the last 9 years, 25 extremely premature infants (less than 1,000 g, mean gestational ages of 26.6 weeks, mean birth weight of 838 g) underwent ligation of PDA in operating room. There were no deaths related to surgery. Nineteen (76%) of these infants with RDS were discharged from the hospital, but five died of sepsis, and one died with poor nutrition. In nineteen survivors, 12 infants (63%) with gestational ages under 28 weeks had complicated bronchopulmonary dysplasia (BPD) but all developed normally with good nutrition due to sufficient lactation and fluid therapy after PDA ligation. Results indicate that PDA ligation in extremely premature infants is a safe and effective procedure, because it will prevent the development of BPD and give these infants body weight gain with good nutrition.