title: Modified extrapleural ligation of patent ductus arteriosus: a convenient surgical approach in a developing country.
abstract: BACKGROUND
  Minimally invasive surgery for the closure of a large patent ductus arteriosus (PDA) using an extrapleural technique offers an alternative to other minimally invasive approaches such as video-assisted thoracoscopic surgery or interventional cardiologic procedures.
  
  
  METHODS
  Between August 1999 and December 2003, 513 patients with PDA were admitted to Unidad de Cirugia Cardiovascular de Guatemala, of whom 327 (64%) were considered surgical candidates. Of these, 218 (67%) were selected for surgical extrapleural (SEP) closure initially by weight (< 10 kg) and a ductal diameter at the pulmonary end of greater than 4 mm. Subsequently, we included also patients who weighed more than 10 kg. Median age at operation was 51 months (range 5 days to 38 years).
  
  
  RESULTS
  Median operating time was 32 minutes (range 23 to 52 minutes). All 218 patients had SEP closure and were extubated in the operating room. There were no hospital deaths. Two patients required a blood transfusion. Two additional patients bled postoperatively, requiring reoperation. A pneumothorax occurred in 3 patients that required a chest tube. The 6-month follow-up revealed residual ductal shunts in 2 patients that were closed percutaneously with a coil. The treatment of the remaining 295 patients included a surgical transpleural (STP) approach in 109 (37%) and transcatheter closure in 186 (63%), with a coil in 110 (37%) and an Amplatzer device in 76 (26%).
  
  
  CONCLUSIONS
  Minimally invasive closure of a PDA through a short, 3-cm to 5-cm skin and muscle-sparing posterior thoracotomy and an SEP approach provides a convenient and safe technique with a low incidence of complications and also a cost-saving option compared with other invasive techniques.
authors.affiliation: Unidad de Cirugia Cardiovascular de Guatemala (UNICAR), Guatemala Ciudad, Guatemala.
authors.forename: Juan
authors.initials: J
authors.lastname: Leon-Wyss
authors.forename: Vladimiro L
authors.initials: VL
authors.lastname: Vida
authors.forename: Oscar
authors.initials: O
authors.lastname: Veras
authors.forename: Ivan
authors.initials: I
authors.lastname: Vides
authors.forename: Guillermo
authors.initials: G
authors.lastname: Gaitan
authors.forename: Mauricio
authors.initials: M
authors.lastname: O'Connell
authors.forename: Aldo R
authors.initials: AR
authors.lastname: Castañeda
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003363:Cost Control; D004374:Ductus Arteriosus, Patent / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006166:Guatemala; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay / Q000191:economics; D008026:Ligation / Q000379:methods*; D008297:Male; D013908:Thoracotomy / Q000379:methods