Successful surgical closure of an arterial duct in 18 children in a third world country.
OBJECTIVE
To perform surgical closure of a clinically significant arterial duct on children in a third world country.


BACKGROUND
An arterial duct is one of the most common congenital cardiac defects. Large arterial ducts can cause significant pulmonary overcirculation, causing symptoms of congestive cardiac failure, ultimately resulting in premature death. Closure of an arterial duct is usually curative, allowing for a normal quality of life and expectancy. In western countries, arterial duct closure in children is usually performed by deployment of a device through a catheter-based approach, replacing previous surgical approaches. In third world countries, there is limited access to the necessary resources for performing catheter-based closure of an arterial duct. Consequently, children with an arterial duct in a third world country may only receive palliative care, can be markedly symptomatic, and often do not survive to adulthood.


METHODS
We assembled a team of 11 healthcare workers with extensive experience in the medical and surgical management of children with congenital cardiac disease. In all, 21 patients with a history of an arterial duct were screened by performing a comprehensive history, physical, and echocardiogram at the Angkor Hospital for Children in Siem Reap, Cambodia.


RESULTS
A total of 18 children (eight male and ten female), ranging in age from 10 months to 14 years, were deemed suitable to undergo surgery. All patients were symptomatic, and the arterial ducts ranged in size from 4 to 15 millimetres. Surgical closure was performed using two clips, and in four cases with the largest arterial duct, sutures were also placed. All patients had successful closure without any significant complications, and were able to be discharged home within 2 days of surgery. Of note, four children with arterial ducts died in the 5 months before our arrival.


CONCLUSIONS
Surgical closure of an arterial duct can be performed safely and effectively by an experienced paediatric cardiothoracic surgical team on children in a third world country. We hope that our experience will inspire others to perform similar missions throughout the world.
Grossfeld
Paul
P
Division of Pediatric Cardiology, University of California, San Diego School of Medicine (UCSD), San Diego, CA, USA. pgrossfeld@ucsd.edu
Greenberg
Mark
M
Saw
Sandra
S
Cheng
Gloria
G
Stanzi
Anthony
A
Mathewson
James
J
Pises
Ngeth
N
Lyda
Luy
L
Vuthy
Sar
S
Elias
William
W
Moriarty
Stephanie
S
Levy
Sharon
S
Walter
Deborah
D
Panzarella
Phillip
P
Grossfeld
Susan
S
Kriett
Jolene
J
Madani
Michael
M
D000293:Adolescent; D002160:Cambodia; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003906:Developing Countries; D004374:Ductus Arteriosus, Patent / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D013318:Stroke Volume; D016896:Treatment Outcome