SURGICAL LIGATION OF PATENT DUCTUS ARTERIOSUS IN A NONCARDIAC SURGICAL CENTRE

Authors

  • Anwar -ul- Haq
  • Ubaid ullah
  • Sami ullah
  • Javeria Javeria
  • Neelofar Neelofar
  • M. Zaheer Abbasi

Abstract

Background: Surgery for Patent Ductus Arteriosus (PDA) is usually performed in specialized cardiaccentres with either open surgery or percutaneous embolisation using different materials and devices.This involves high cost of treatment especially for those poor patients who have grown up to severalyears of age without seeking any treatment for their disease. The objective of this study is to evaluatethe safety of surgery for PDA in a non cardiac paediatric surgical setup. Methods: A total of 89 patientsof 8 months to 12 years (mean 3 years) age were operated over a period of 13 years (from 1993 to2006). Fifty-five cases were females and 34 were males. Investigations included x-ray chest, ECG andechocardiography. All patients with PDA were included in the study except those who had otherassociated cardiac anomaly and those who had a calcified ductus. The ductus was dissected out andligated with non-absorbable suture (Silk No. 1 or 2). The patients were discharged by the 5th postoperative day. Results: In majority of the patients the recovery was smooth and uneventful. Eightpatients had minor complications which were treated conservatively. There were 3 mortalities in thisseries; 2 patients were over 10 years of age and had calcified ductus. They died during surgery due toprimary haemorrhage and 1 died after 24 hours in the intensive care unit. All patients were reviewed at1 week, 1 month, 3 months and 1 year after surgery. In majority, the typical machinery murmurdisappeared immediately or a soft systolic murmur persisted for up to 4 weeks and then disappeared.Conclusion: With proper patient selection, the procedure can safely be performed in a paediatricsurgical setup with facilities for cardiac monitoring. The surgeon needs to receive some additionaltraining in the cardiac institution for safe surgery on these children. This will significantly reduce thecost with minimal complications especially for those poor patients who cannot afford the modernprocedures due to monitory constraints. Children older than 10 years are not suitable for open surgerybecause of calcification of the duct.Keywords: Patent ductus arteriosus, surgical ligation, cardiac surgery

References

Gross RE, Hubbard JP. Surgical ligation of patent ductus

arteriosus. Report of first successful case. JAMA

;112:729–31.

Blalock A. Operative closure of patent ductus arteriosus. Surg

Gynecol Obstet 1946;82:113–4.

Sharpiro MJ. Results of surgery in patent ductus arteriosus. Arch

Surg 1949;58:612–22.

Zaheer A, Mumtaz H, Aleya K. Safety of ligation of patent

ductus arteriosus in a non cardiac surgical center. J Surg

;15&16:34–6.

Van OB. Patent ductus arteriosus: How aggressive should we be?

Neonatology 2007;91:318.

Little DC, Pratt TC, Blalock SE, Krauss DR, Cooney DR, Custer

MD. Patent ductus arteriosus in micropreemies and full-term

infants. The relative merits of surgical ligation versus

indomethacin treatment. J Pediatr Surg 2003;38:492–6.

Gould DS, Montenegro LM, Gaynor JW, Lacy SP, Ittenbach R,

Stephens P, et al. A comparison of on-site and off-site patent

ductus arteriosus ligation in premature infants. Pediatrics

;112:1298–301.

Radtke WA. Current therapy of the patent ductus arteriosus. Curr

Opin Cardiol 1998;13:59–65.

Grifka RG. Transcatheter PDA closure. Equipment and

technique. J Interv Cardiol 2001;14:97–107

Mavroudis C, Backer CL, Gevitz M. Forty-six years of patient

ductus arteriosus division at Children's Memorial Hospital of

Chicago: Standards for comparison. Ann Surg 1994;220:402–10.

Zamfir CR, Vernet M, Funes VM, Sapin E. Patent ductus

arteriosus ligation: the LigaSure system may be unreliable. Ann

Thorac Surg 2007;83:2228–30.

J Ayub Med Coll Abbottabad 2009;21(3)

http://www.ayubmewd.edu.pk/JAMC/PAST/21-3/Anwar.pdf

Toyama S, Shimizu A, Takahashi N, Seki M, Takagi T, Kitahara

Y, Hatori F. Usefulness of transesophageal echocardiography to

evaluate the completeness of pediatric patent ductus arteriosus

ligation. Masui 2007;56:169–72.

Ho AC, Tan PP, Yang MW, Yang CH, Chu JJ, Lin PJ, et al. The

use of multiplane transesophageal echocardiography to evaluate

residual patent ductus arteriosus during video-assisted

thoracoscopy in adults. Surg Endosc 1999;13:975–9.

Portsmann W, Wierny L, Warnke H. Catheter closure of patent

ductus arteriosus. 62 cases treated without thoracotomy. Radiol

Clin North Am 1971;9:203–18.

Wessel DL, Keane JF, Parness I, Lock JE. Outpatient closure of

the patent ductus arteriosus. Circulation 1988;77:1068–71.

European registry. Transcatheter occlusion of persistent arterial

duct. Lancet 1992;340:1062–6.

Goodrich KR, Kyles AE, Kass PH, Campbell F. Retrospective

comparison of surgical ligation and transarterial catheter

occlusion for treatment of patent ductus arteriosus in two hundred

and four dogs. Vet Surg 2007;36(1):43–9.

Fujii Y, Keene BW, Mathews KG, Atkins CE, Defrancesco TC,

Hardie EM, Wakao Y. Coil occlusion of residual shunts after

surgical closure of patent ductus arteriosus. Vet Surg

;35:781–5.

Vanamo K, Berg E, Kokki H, Tikanoja T. Video-assisted

thoracoscopic versus open surgery for persistent ductus

arteriosus. J Pediatr Surg 2006;41:1226–9.

Pereira KD, Webb BD, Blakely ML, Cox CS, Lally KP.

Sequelae of recurrent laryngeal nerve injury after patent

ductus arteriosus ligation. Int J Pediatr Otorhinolaryngol

;70:1609–12.

Suematsu Y, Mora BN, Mihaljevic T, del Nido PJ. Totally

endoscopic robotic-assisted repair of patent ductus arteriosus and

vascular ring in children. Ann Thorac Surg 2005;80:2309–13.

Leon-Wyss J, Vida VL, Veras O, Vides I, Gaitan G, O'Connell

M, Castañeda AR. Modified extrapleural ligation of patent ductus

arteriosus: a convenient surgical approach in a developing

country. Ann Thorac Surg 2005;79:632–5.

Jacobs JP, Giroud JM, Quintessenza JA, Morell VO, Botero LM,

van Gelder HM, Badhwar V, Burke RP. The modern approach to

patent ductus arteriosus treatment: complementary roles of videoassisted thoracoscopic surgery and interventional cardiology coil

occlusion. Ann Thorac Surg 2003;76:1421–7.

Radhakrishnan S, Marwah A, Shrivastava S. Non-surgical

closure of large ductus arteriosus using Amplatzer Duct Occluder

feasibility and early follow-up results. Indian J Pediatr

;68(1):31–5.

Elsisi A, Tofeig M, Arnold R, Peart I, Kitchiner DJ, Bu'Lock FA,

Walsh KP. Mechanical occlusion of the patent ductus arteriosus

with Jackson coils. Pediatr Cardiol 2001;22(1):29–33.

Podnar T, Masura J. Transcatheter occlusion of residual patent

ductus arteriosus after surgical ligation. Pediatr Cardiol

;20(2):126–30.

Raval MV, Laughon MM, Bose CL, Phillips JD. Patent ductus

arteriosus ligation in premature infants: who really benefits, and

at what cost? J Pediatr Surg 2007;42(1):69–75.

Lee LC, Tillett A, Tulloh R, Yates R, Kelsall W. Outcome

following patent ductus arteriosus ligation in premature infants: a

retrospective cohort analysis. BMC Pediatr 2006;6:15.

Laborde F, Noirhomme P, Karam J, Batisse A, Bourel P,

Maurice OS. A new video assisted thoracoscopic surgical

technique for interruption of patent ductus arteriosus in infants

and children. J Thorac Cardiovasc Surg 1993;105:270–80.

Alvarez-Tostado RA, Millan MA, Tovat LA, Shuchleib S,

Alvarez-Tostado R, Chousleb A. Thoracoscopic clipping and

ligation of a patent ductus arteriosus. Ann Thorac Surg

;57:755–7

Gray DT, Fyler DC, Walker AM, Weinstein MC, Chalmers TC..

Clinical outcomes and costs of transcatheter as compared with

surgical closure of patent ductus arteriosus. N Engl J Med

;329:1517–23

Thomas L, Forbes, Mark GE. Optimal elective management of

Patent ductus arteriosus in older child. J Pediatr Surg

;31:765–7.

Published

2009-09-01

Issue

Vol. 21 No. 3 (2009): JOURNAL OF AYUB MEDICAL COLLEGE, ABBOTTABAD

Section

ORIGINAL ARTICLE

License

Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License  CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.

USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.

AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.