Video-assisted thoracoscopic surgical (VATS) closure of Patent Ductus Arteriosus: report of three-hundred cases.
BACKGROUND
Video-Assisted Thoracoscopic Surgery (VATS) has recently been used for Patent Ductus Arteriosus (PDA) closure on a routine basis. Our experience with this technique is supporting its efficacy. The results and advantages of VATS are the same as when thoracotomy is being performed.


METHODS
From June 1997 to October 2000, there were 300 consecutive patients (mean age: 6 years old) with PDA recognized by echocardiography and/or cardiac catheterization, on whom VATS were studied. With the patients under general anesthesia, three 5 mm holes were made through the left thoracic wall. A video camera and specialized surgical devices were introduced. The ductus was dissected, and two titanium clips were applied for complete closure of the ductus. Exclusion criteria were: 1) Diameter of the ductus > 9 mm, 2) Complicated PDA such as aneurysm formation, endocarditis, and calcification, 3) Pleural adhesion and/or left sided thoracic operation in the past.


RESULTS
All cases were re-assessed immediately after the procedure, and followed up by control echocardiography. No significant complication and residual shunt was recorded during the observation period. The procedure was changed to thoracotomy in three adult patients due to an inappropriately dilated canal (>9mm). Moreover, two other patients developed transient recurrent laryngeal nerve dysfunction. Mean procedure time was about 20 +/- 2 minutes. All patients were discharged shortly after the procedure (approximately 20 hours).


CONCLUSIONS
Our results suggest that VATS compared to other techniques for PDA closure is rapid, cost-effective, painless and more cosmetic.
Nezafati
M H
MH
Department of Cardiovascular Surgery, Ghaem Hospital Medical Center, MUMS, Mashhad, Iran. Nezafati@mums.ac.ir
Mahmoodi
E
E
Hashemian
S H
SH
Hamedanchi
A
A
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004374:Ductus Arteriosus, Patent / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D020775:Thoracic Surgery, Video-Assisted