New minimally invasive technique of perpulmonary device closure of patent ductus arteriosus through a parasternal approach.
BACKGROUND
Transcatheter closure and previous surgical techniques of patent ductus arteriosus (PDA) have different drawbacks. We describe a new minimally invasive technique of perpulmonary device closure of a PDA and evaluate the feasibility, safety, and advantages of this technique.


METHODS
Seventy-nine patients aged 0.4 to 52 years (mean, 18±15 years) underwent perpulmonary device closure of PDA. A 2- to 3-cm parasternal incision was made in the left second intercostal space. The pericardium was incised. A specially designed delivery sheath loaded with the device was inserted through the pursestring sutures into the pulmonary trunk. Under transesophageal echocardiographic guidance, it was advanced through the PDA into the descending aorta, and the device was subsequently deployed. In patients with a large PDA or significant pulmonary hypertension, a device stay suture was passed through the device and tied down with the pursestring sutures after device release to avoid device dislocation.


RESULTS
The procedure was successful in 78 patients (99%). The device stay suture was used in 21 patients. The mean minimum PDA diameter was 6.0±3.4 mm (range, 1.7 to 18.0 mm). The implanted device size was 9.6±4.1 mm (range, 4 to 24 mm). The mean intrapulmonary manipulation time was 15±13 minutes (range, 2 to 55 minutes). During the follow-up period of 3 to 24 months, a minor residual shunt was found in 2 patients.


CONCLUSIONS
Perpulmonary device closure of a PDA is simple, safe, and efficacious. It has the advantages of more accurate device positioning and reduces the risk of device embolization by using the device stay suture.
Department of Cardiovascular Surgery, Provincial Hospital Affiliated to Shandong University, Jinan, China. hongxinli@hotmail.com
Li
L
Hongxin
Guo
G
Wenbin
Mei
M
Zhu
Fei
F
Liang
Wenlong
W
Zhang
Haroon
H
Mujahid
Chengwei
C
Zou
D000293:Adolescent; D000328:Adult; D006348:Cardiac Surgical Procedures / Q000379:methods; D002648:Child; D002675:Child, Preschool; D004374:Ductus Arteriosus, Patent / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D011474:Prosthesis Design; D055989:Septal Occluder Device; D013249:Sternum; D055815:Young Adult