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Optimal elective management of patent ductus arteriosus in the older child
1Division of Paediatric Surgery, University of Western Ontario, Canada.
Insights
Open surgical ligation effectively closes patent ductus arteriosus (PDA) in children. This study confirms its safety and success, with no deaths or major complications in 42 pediatric patients.
Area of Science:
- Pediatric Surgery
- Cardiovascular Surgery
- Neonatal Medicine
Background:
- Patent ductus arteriosus (PDA) is a common congenital heart defect.
- Surgical ligation remains a standard treatment for PDA.
- Minimally invasive techniques are emerging as alternatives.
Purpose of the Study:
- To evaluate the safety and efficacy of open surgical ligation for PDA in children.
- To analyze outcomes, complications, and resource utilization for this procedure.
Main Methods:
- Retrospective review of 42 children undergoing elective PDA ligation via limited left posterolateral thoracotomy.
- Preoperative diagnosis confirmed by echocardiography.
- Closure achieved with silk ligatures or a combination of ligature and clip.
Main Results:
- No deaths or major surgical complications occurred.
- Successful PDA closure confirmed in all patients.
- Hospitalization averaged 3.1 days with no transfusions required.
Conclusions:
- Open surgical ligation is a safe and effective method for PDA closure in pediatric patients.
- The procedure demonstrated a low complication rate and favorable outcomes.
- This technique remains a viable option for elective PDA management.
Abstract:
Open surgical ligation has proven to be a safe and effective method to bring about closure of the patent ductus arteriosus (PDA). Recent studies have suggested that percutaneous transcatheter and video-assisted thorascopic closure may be better and more cost-effective techniques for PDA closure. The authors reviewed their experience with open thoracotomy for the elective ligation of PDA in 42 children over a 3-year period. The male:female ratio was 1.6:1; the age of the patients (mean +/- SD) was 2.8 +/- 2.3 years and their weight was 14 +/- 7 kg. In all cases the diagnosis was confirmed preoperatively by echocardiography. Open ligation of the PDA was performed through a limited left posterolateral thoracotomy with exposure, by an extrapleural approach. Closure was established with two silk ligatures or a silk ligature and clip, and drainage of the extrapleural space was not used. The operating time was 85 +/- 12 minutes. The total duration of hospitalization was 3.1 +/- 0.8 days. There were no deaths. Successful closure was confirmed by auscultation in 39 children and by subsequent echocardiography in three patients. No surgical complications occurred, and no transfusions were required. Minor respiratory symptoms occurred in two patients postoperatively. Transient systemic hypertension was seen in two patients, and one wound infection occurred.