Video surgical technique for interruption of patent ductus arteriosus in children and neonates

Abstract

Summary. Classical surgical interruption of PDA has partially been replaced by trans catheter endovascular closure since 1971. We describe a new technique for PDA closure by video surgery. With the patient under general anesthesia and intubated, two 5 mm holes were made through the left thoracic wall. A video camera and specially devised surgical tools were introduced, such as scissors, dissecting forceps, clip appliers. The ductus was dissected and two titanium clips were applied, completely interrupting the ductus. 282 patients were operated on from April1991. Mean age was 20 months (range 1 month to 17 years) and mean weight was 13 kg (range 1.2 to 65 kg) Twenty-one had associated lesions not necessitating immediate surgical treatment. All had successful closure of the patent ductus with the video-assisted technique. 6 patients had recurrent laryngeal nerve injury (5 transient, 1 permanent). The usual hospital stay was from 48h to 72h. There were no other complications and no deaths. Video surgery is a rapid, safe and successful technique for closure of the patent ductus arteriosus. This technique is feasible in low-weight and premature infants.Patent ductus arteriosus (PDA) was the first congenital cardiovascular disease to be surgically managed. Since this period, indications for treatment are clearly defined by the fact that a patent ductus must be closed. The optimal period of time for this interruption depends on different factors that must be considered. Large ducti are responsible for important left to right shunts and can be symptomatic early after birth and cause refractory congestive heart failure: indication for surgical repair is unequivocal in this group and must be done rapidly. For other patients with an asymptomatic persistent patent ductus, indication of interruption remains, because of the hemodynamic and pulmonary consequences of the persistent left to right shunt and also because of the risk, although rare, of bacterial endocarditis development.Until 1971, the only available technique was surgical interruption through a left thoracotomy. After this period, a technique of cndovascular nonsurgical closure of PDA was described. After numerous modifications of different devices, in 1981, clinical trials were run and the rate of success evaluated by many investigators and nowadays the results and the limits of this non surgical technique are presently known.We now present the results of a new technique for complete interruption of PDA using a video surgical technique and suitable for premature babies to children. This technique gives less discomfort and morbidity than the classic surgical thoracotomy and provides a guarantee of success.

Minimally Invasive Patent Ductus Arteriosus Occlusion in 5 Dogs

“…One notable advantage associated with the use of hemostatic clips is that they can be applied endoscopically and therefore can be incorporated into a minimally invasive technique for PDA occlusion. Thoracoscopic PDA occlusion has been performed in human infants since 1991 8 and is associated with a success rate similar to open ligation but with a lower complication rate 8–17 …”

“…PDA occlusion using hemostatic clips can be performed with minimal dissection of the ductus. This technique has been described in dogs 7 and is used for minimally invasive PDA occlusion in humans 8–16 . Video‐assisted thoracoscopic surgical closure of PDA in infants was first described in 1991 8 and is routinely performed in some centers 8–11,17 .…”

“…This technique has been described in dogs 7 and is used for minimally invasive PDA occlusion in humans 8–16 . Video‐assisted thoracoscopic surgical closure of PDA in infants was first described in 1991 8 and is routinely performed in some centers 8–11,17 . Considering the potential benefit of using minimally invasive PDA occlusion in canine patients (reduced tissue trauma, postoperative pain and hypothermia, shortened recovery period), we investigated the feasibility of this novel approach in canine surgery.…”