title: Less invasive surgical closure of patent ductus arteriosus in extremely low birth weight infants.
abstract: Minimally invasive surgery is widely used in pediatric surgery. Extremely low birth weight infants (ELBWI) are literally so fragile to surgical stress that the minimum invasive procedures should be required. We report 15 ELBWI cases with patent ductus arteriosus (PDA), who underwent surgical closure. All of them had failed treatment with indomethacin to close PDA or had contraindicated to its use. The mean gestational age at birth was 26.0+/-2.7 weeks (24-34 weeks) and birth weight 702+/-140 g (479-966 g). The mean age at operation was 23+/-11 days (2-48 days) and body weight at operation 679+/-151 g (428-969 g). The surgery-related mortality was none. No complications were also encountered. Our surgical procedures consist of 2 modalities, one is clipping PDA, not ligation. Clipping technique attributes to minimize the dissection of surrounding tissue of PDA. The other is posterolateral muscle sparing thoracotomy, which would reduce long-term physical impairment and deformity. We believe our surgical technique can be accomplished safely and would be an alternative approach for ELBWI with a lower probability of PDA closure with indomethacin or an increased risk of complications for medical treatment.
authors.affiliation: Department of Cardiovascular Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan.
authors.forename: Jinichi
authors.initials: J
authors.lastname: Iwase
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Tajima
authors.forename: Akinori
authors.initials: A
authors.lastname: Io
authors.forename: Wataru
authors.initials: W
authors.lastname: Katoh
authors.forename: Keisuke
authors.initials: K
authors.lastname: Tanaka
authors.forename: Sachie
authors.initials: S
authors.lastname: Toki
authors.forename: Mitsuji
authors.initials: M
authors.lastname: Iwasa
authors.forename: Hisanori
authors.initials: H
authors.lastname: Sobajima
authors.forename: Yasumasa
authors.initials: Y
authors.lastname: Yamada
authors.forename: Hiroe
authors.initials: H
authors.lastname: Takasu
mesh_terms: D004374:Ductus Arteriosus, Patent / Q000601:surgery*; D006801:Humans; D007229:Infant Welfare; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D007564:Japan; D019060:Minimally Invasive Surgical Procedures; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D016019:Survival Analysis; D016896:Treatment Outcome