Video-assisted thoracoscopic surgical interruption: the technique of choice for patent ductus arteriosus. Routine experience in 230 pediatric cases.
Video-assisted thoracoscopic surgical interruption for patient ductus arteriosus is a well-standardized procedure already described. We present our entire series of such cases, from the first case (performed on Sept. 5, 1991) to March 1, 1995. Two hundred thirty patients in a variety of age groups underwent video-assisted interruption: younger than 6 months (70 patients, 30%), 6 to 48 months (123 patients, 54%), and older than 48 months (37 patients, 16%). The mean weight was 12.6 kg (range 1.2 to 65 kg). Thirty-nine patients had symptomatic pulmonary hypertension. Associated intracardiac anomalies included atrial septal defect (three), ventricular septal defect (five), and anomalous pulmonary venous return (one). All patients underwent video-assisted interruption of the patient ductus arteriosus with two titanium clips. Closure was evaluated by postoperative echocardiography before extubation. Five patients had a persistent patent ductus after video-assisted interruption, all early in our experience and related to insufficient dissection resulting in inadequate clip placement. Four patients had successful immediate clip repositioning (three by video-assisted interruption and one by thoracotomy). Subsequent echocardiography revealed persistent closure in these patients. A persistent patent ductus arteriosus with minimal flow was discovered in one patient without symptoms after discharge. Recurrent laryngeal nerve dysfunction was noted in six patients (2.6%, five transient and one persistent). There were no deaths, hemorrhages, transfusions required, or chylothoraces in this series. Mean operative time was 20 +/- 15 minutes, and hospital stay averaged 48 hours for patients younger than 6 months and 72 hours for patients older than 6 months. This is a safe, rapid, cost-effective technique that results in excellent results and a shortened hospital stay. Video-assisted interruption represents the technique of choice for closure of a patient ductus arteriosus.
Department of Cardio-pediatric Surgery, Centre Médico-Chirurgical de la Porte de Choisy, Paris, France.
F
F
Laborde
T
T
Folliguet
A
A
Batisse
A
A
Dibie
E
E
da-Cruz
D
D
Carbognani
D002675:Child, Preschool; D004374:Ductus Arteriosus, Patent / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D018618:Echocardiography, Doppler, Color; D004724:Endoscopy / Q000379:methods* / Q000706:statistics & numerical data; D006330:Heart Defects, Congenital / Q000150:complications; D006801:Humans; D007223:Infant; D007902:Length of Stay; D011183:Postoperative Complications / Q000453:epidemiology; D013906:Thoracoscopy / Q000379:methods*; D013997:Time Factors; D014741:Video Recording