TITLE

Paediatric video-assisted thoracoscopic clipping of patent ductus arteriosus: experience in more than 700 cases

AUTHOR(S)
Villa, Emmanuel; Eynden, Frédéric Vanden; Bret, Emmanuel Le; Folliguet, Thierry; Laborde, François
PUB. DATE
March 2004
SOURCE
European Journal of Cardio-Thoracic Surgery;Mar2004, Vol. 25 Issue 3, p387
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Objective: To overcome drawbacks of thoracotomy and percutaneous techniques, we have performed video-assisted thoracoscopic surgery (VATS) since 1991 to treat patent ductus arteriosus (PDA). This retrospective study aims to analyse morbidity and outcome in order to add data in the evaluation of minimally invasive operations. Methods: From September 1991 to March 2003, 703 patients underwent PDA clipping by VATS. The indications for operation were clinically significant patency or failure to close in older children. Diameter >8 mm, previous thoracotomy, calcifications, infection, or aneurysm were contraindications to VATS. In right decubitus, only two thoracostomy incisions (for 5-mm trocars) and a smaller one (for direct hook insertion) were required. In the post-operative stay two echocardiographic controls were scheduled, the first before extubation and the second before discharge. Referring cardiologists assured follow-up. Results: Mean age was 3.0±3.8 years (5 days–33 years), mean weight 10.7±8.0 kg (1.2–65 kg), and 3.1% of our activity were low birth-weight infants (LBWIs) weighting ≤2.5 kg. Operative and 30-day mortality was nil. Median operative time was 20 min and median stay 2 days. Unfavourable events globally occurred in 6.8% of cases (13.6% of the LBWIs, RR 4.0, CL 95% 1.5–10.4). Recurrent laryngeal nerve injury was noted in 3% (13.6% of the LBWI, RR 5.1, CL 95% 1.6–15), but only 0.4% had long lasting dysfunction. Incidence of chylothorax was 0.6%, thoracotomy 1%, transfusion for bleeding 0.1%, pneumothorax 1.3%. LBWIs were at increased risk for the latter two events. Residual patency was detected immediately in 1.4% (all non-LBWI) and underwent additional surgery. Incidence of residual patency at follow-up was 0.6% (0% LBWI, 0.6% in 2.5–25 kg group, 5.0% in >25 kg group, P=0.001). Conclusions: This study records a long experience of PDA treatment in a wide range of body size and age. VATS clipping is safe, but LBWIs are at augmented risk of complication. It may be carried out with a high degree of efficacy in all the ductus diameters <9 mm. VATS clipping requires minimal operating time and avoids morbidity related to chest wall trauma, percutaneous vascular access, and intravascular foreign bodies.
ACCESSION #
12436029

 

Related Articles

  • Transcatheter Closure of a Large Patent Ductus Arteriosus in a Young Child Using the Amplatzer Duct Occluder. Jan, S.-L.; Hwang, B.; Fu, Y.-C.; Chi, C.-S. // Pediatric Cardiology;Sep/Oct2005, Vol. 26 Issue 5, p703 

    The Amplatzer duct occluder (ADO) provides a safe and effective therapy for patients with moderate- to large-sized patent ductus arteriosus (PDA), but there have been few reports of transcatheter closure of very large PDAs in young children and infants. We report a successful transcatheter...

  • Pulmonary hypertension following L-lysine ibuprofen therapy in a preterm infant with patent ductus arteriosus. Bellini, Carlo; Campone, Francesco; Serra, Giovanni // CMAJ: Canadian Medical Association Journal;6/20/2006, Vol. 174 Issue 13, p1843 

    Patent ductus arteriosus is one of the most common congenital abnormalities found in premature infants. Ibuprofen, a nonsteroidal drug that is commonly used as an antipyretic, analgesic and anti-inflammatory agent, is also used to induce closure of symptomatic patent ductus arteriosus in preterm...

  • Paracetamol Therapy for Patent Ductus Arteriosus in Premature Ä°nfants: A Chance Before Surgical Ligation. Özdemir, Özmert; Doğan, Mustafa; Küçüktaşçı, Kazım; Ergin, Hacer; Şahin, Özlem // Pediatric Cardiology;Feb2014, Vol. 35 Issue 2, p276 

    Patent ductus arteriosus (PDA) remains a common problem in premature infants. Treatment options include pharmacologic therapy and surgical ligation, but these are associated with potentially significant adverse effects. This report describes the effect of administering oral paracetamol to...

  • Vascular plug for PDA closure found effective in children.  // Cardiology Today;Sep2013, Vol. 16 Issue 9, p16 

    The article focuses on the findings of a retrospective study which revealed the safe and effective use of an Amplatzer duct occluder for the closure of medium- and small-sized patent ductus arteriosus in children and symptomatic infants.

  • Diameter of the ductus arteriosus as a predictor of patent ductus arteriosus (PDA). Nowak, Dariusz; Kozlowska, Hanna; Zurada, Anna; Gielecki, Jerzy // Central European Journal of Medicine;Aug2011, Vol. 6 Issue 4, p418 

    Patent ductus arteriosus (PDA) is the most prevalent cardiovascular defect and is more often seen in females; premature babies are at increased risk. For both sexes, a relationship exists between the risk of this defect occurring and the higher dimensions of the ductus arteriosus. In this study,...

  • Large patent ductus arteriosus in an adult complicated by pulmonary endarteritis and embolic lung abscess. Navaratnarajah, Manoraj; Mensah, Kwabena; Balakrishnan, Mahesh; Raja, Shahzad G.; Bahrami, Toufan // Heart International;2011, Vol. 6 Issue 2, p57 

    Patent ductus arteriosus in the adult is an extremely rare clinical phenomenon. We report the case of a 34-year old man who developed pulmonary endarteritis and subsequent embolic lung abscess secondary to a large patent ductus arteriosus. This brief report also provides an overview of the...

  • Underestimation of the Severity of Pulmonary Outflow Tract Obstruction in the First Day of Life - Doppler Echocardiographic Study. Robida, Andrej // Angiology;Mar1996, Vol. 47 Issue 3, p267 

    To find out whether there is an underestimated severity of narrowing in obstructive lesions of the pulmonary outflow tract in the first day of life, Doppler measurement of the pulmonary outflow tract gradient and estimation of the pulmonary artery systolic pressure in 15 neonates with pulmonary...

  • Transcatheter closure of patent ductus arteriosus with severe pulmonary arterial hypertension in adults. Yan, C.; Zhao, S.; Jiang, S.; Xu, Z.; Huang, I.; Zheng, H.; Ling, J.; Wang, C.; Wu, W.; Hu, H.; Zhang, G.; Ye, Z.; Wang, H. // Heart;Apr2007, Vol. 93 Issue 4, p514 

    Background: Surgical closure of patent ductus arteriosus (PDA) with severe pulmonary arterial hypertension in adults carries higher risk than in children. Objectives: To investigate the application of self-expandable occluders for transcatheter closure of PDA associated with severe pulmonary...

  • Does patent ductus arteriosus affect feed tolerance in preterm neonates? Patole, S. K.; Kumaran, V.; Travadi, J. N.; Brooks, J. M.; Doherty, D. A. // Archives of Disease in Childhood -- Fetal & Neonatal Edition;Jan2007, Vol. 92 Issue 1, pF53 

    Patent ductus arteriosus (PDA), especially PDA with sepsis, has been reported as a risk factor for feed intolerance in preterm neonates. In this study, the start to full feeds interval was found to be longest in preterm neonates (⩽ 28 weeks' gestation) with sepsis, followed by that in...

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics