[Video-assisted surgery for closure of persistent ductus arteriosus. Study in sheep and initial clinical experience].
OBJECTIVE
The aim of this study was to analyse the effectiveness of patent ductus arteriosus (PDA) closure by the video-assisted thoracic surgery (VATS).


METHODS
The technique was utilized in 6 newborn lambs firstly. Three to four small incisions (3 to 10mm) were used in each animal to permit the introduction of lung retractors, video equipment, dissectors and clip appliers. The procedure was accompanied by video monitoring and after the dissection, the PDA was closed by 2 titanium clips. Seven days after, the animals were sacrificed and submitted to pathological study. Based on this initial experience seven patients (ages between 17 and 108 months) were operated on with this technique.


RESULTS
In lambs, we have some difficulty to retract the lung. Despite this fact the closure of PDA was successful and proved by pathologic study. In children the dissection of PDA was easier due to manual ventilation. The interruption of PDA using the proposed method was obtained in 4 patients, those with good relation between ductus diameter and clip size and defined by echocardiography and angiographic studies.


CONCLUSIONS
The use of VATS for interruption of PDA in both, experimental and initial clinical experiences, has showed to be an effective method.
Jatene
F B
FB
Instituto do Coração do Hospital das Clínicas, FMUSP.
Assad
R S
RS
Pêgo-Fernandes
P
P
Jatene
M B
MB
Monteiro
R
R
Aiello
V D
VD
Rocha e Silva
R
R
Barbero-Marcial
M
M
Jatene
A D
AD
D000818:Animals; D000831:Animals, Newborn; D006348:Cardiac Surgical Procedures / Q000379:methods; D002648:Child; D002675:Child, Preschool; D004374:Ductus Arteriosus, Patent / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012756:Sheep