Current therapy of the patent ductus arteriosus.
The patent ductus arteriosus (PDA) was the first congenital heart lesion to be treated surgically and also the first to be treated with nonsurgical catheter intervention. Surgical ligation and division of the ductus remains the gold standard for consistently achieving complete occlusion. Transaxillary muscle-sparing thoracotomy and video-assisted thoracoscopic ligation, however, have evolved as surgical alternatives with reduced trauma, shorter hospitalization, and excellent cosmetic result but are associated with a significant rate of residual or recurrent duct patency. With aggressive application of critical pathway methods, significant reduction in cost has been achieved for surgical PDA closure. Nonsurgical transcatheter closure nevertheless has gained widespread acceptance, mostly employing detachable or nondetachable stainless steel coils. Coils have superseded the previously popular Rashkind PDA occluder (USCI/Bard, Tewksbury, MA) because of significantly lower cost, less cumbersome handling, smaller delivery catheters, and superior occlusion rates. Various coil implantation techniques and detachment mechanisms have been devised. Large PDAs with smallest diameter greater than 5 mm, however, still are better treated surgically until appropriate devices become available.
Radtke
W A
WA
South Carolina Children's Heart Center, Medical University of South Carolina, Charleston 29425, USA.
D000367:Age Factors; D002648:Child; D004374:Ductus Arteriosus, Patent / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D004621:Embolization, Therapeutic; D004724:Endoscopy; D006439:Hemodynamics; D006801:Humans; D008026:Ligation; D013906:Thoracoscopy; D013908:Thoracotomy / Q000379:methods; D016896:Treatment Outcome; D014741:Video Recording