Closure of a large patent ductus arteriosus in children and adults with pulmonary hypertension.
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.
Kalavrouziotis
Georgios
G
Department of Cardiothoracic Surgery, Aghia Sophia Children's Hospital, Athens, Greece. gkalavrouziotis@yahoo.com
Kourtesis
Antonios
A
Paphitis
Christodoulos
C
Azariades
Prodromos
P
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