title: Successful surgical closure of an arterial duct in 18 children in a third world country.
abstract: 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.
authors.affiliation: Division of Pediatric Cardiology, University of California, San Diego School of Medicine (UCSD), San Diego, CA, USA. pgrossfeld@ucsd.edu
authors.forename: Paul
authors.initials: P
authors.lastname: Grossfeld
authors.forename: Mark
authors.initials: M
authors.lastname: Greenberg
authors.forename: Sandra
authors.initials: S
authors.lastname: Saw
authors.forename: Gloria
authors.initials: G
authors.lastname: Cheng
authors.forename: Anthony
authors.initials: A
authors.lastname: Stanzi
authors.forename: James
authors.initials: J
authors.lastname: Mathewson
authors.forename: Ngeth
authors.initials: N
authors.lastname: Pises
authors.forename: Luy
authors.initials: L
authors.lastname: Lyda
authors.forename: Sar
authors.initials: S
authors.lastname: Vuthy
authors.forename: William
authors.initials: W
authors.lastname: Elias
authors.forename: Stephanie
authors.initials: S
authors.lastname: Moriarty
authors.forename: Sharon
authors.initials: S
authors.lastname: Levy
authors.forename: Deborah
authors.initials: D
authors.lastname: Walter
authors.forename: Phillip
authors.initials: P
authors.lastname: Panzarella
authors.forename: Susan
authors.initials: S
authors.lastname: Grossfeld
authors.forename: Jolene
authors.initials: J
authors.lastname: Kriett
authors.forename: Michael
authors.initials: M
authors.lastname: Madani
mesh_terms: 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