title: Closure of a large patent ductus arteriosus in children and adults with pulmonary hypertension.
abstract: BACKGROUND
  Surgical closure of a patent ductus arteriosus (PDA) in cases with pulmonary hypertension, a short and wide PDA, and/or calcification of the wall of the vessel can be a hazardous procedure. The use of extracorporeal circulation provides the necessary safety for effective closure.
  
  
  METHODS
  Four patients (one male), aged 7, 22, 54 and 60 years old, underwent PDA closure. All had pulmonary hypertension (pulmonary artery pressure, PAP 55-85 mmHg, PAP-to-systemic pressure ratio 0.6-0.8) and a wide, short PDA (diameter 9-12 mm) with a calcified wall in 2 cases. The surgical technique involved transpulmonary PDA closure with a synthetic patch under extracorporeal circulation and mild hypothermia (n=2); or double ligation and purse-string suture of the PDA with extracorporeal circulation and normothermia on a beating heart (n=1), or with heart-lung machine on standby (n=1).
  
  
  RESULTS
  Mortality was nil. The postoperative course was mild in all cases. Follow up 3 to 8 years post surgery showed effective PDA closure, PAP within normal (n=3) or at upper normal limits (n=1), and no other sequelae.
  
  
  CONCLUSIONS
  The use of extracorporeal circulation allows safe and uncomplicated surgical closure of a PDA in "difficult" cases.
authors.affiliation: Department of Cardiothoracic Surgery, Aghia Sophia Children's Hospital, Athens, Greece. gkalavrouziotis@yahoo.com
authors.forename: Georgios
authors.initials: G
authors.lastname: Kalavrouziotis
authors.forename: Antonios
authors.initials: A
authors.lastname: Kourtesis
authors.forename: Christodoulos
authors.initials: C
authors.lastname: Paphitis
authors.forename: Prodromos
authors.initials: P
authors.lastname: Azariades
mesh_terms: D000328:Adult; D002648:Child; D004374:Ductus Arteriosus, Patent / Q000150:complications* / Q000601:surgery*; D005112:Extracorporeal Circulation; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome