Skip to main content
PMC home page
Annals of Surgery logoLink to Annals of Surgery
. 1994 Sep;220(3):402–410. doi: 10.1097/00000658-199409000-00016

Forty-six years of patient ductus arteriosus division at Children's Memorial Hospital of Chicago. Standards for comparison.

C Mavroudis 1, C L Backer 1, M Gevitz 1
PMCID: PMC1234402  PMID: 8092906

Abstract

OBJECTIVE: The authors reviewed a large surgical experience (during five decades) with ligation and division of patent ductus arteriosus (PDA) in light of previously reported historical standards and present-day alternatives. SUMMARY BACKGROUND DATA: Ligation of PDA was first performed by Gross in 1938. Various surgical techniques used since then have included ligation and division, simple ligation, and hemaclip application. Recently introduced therapies include percutaneous transcatheter ductal closure devices (PTDC) and video-assisted thoracotomy (VAT). Percutaneous transcatheter ductal closure device protagonists cite surgical recurrence rates as high as 22% to justify continued application. METHODS: Between 1947 and 1993, 98.2% of 1108 patients (premature babies excluded) had interruption of PDA by ligation and division. Recent improvements have included muscle-sparing thoracotomy, minimal use of tube thoracostomy, and same-day surgery. RESULTS: Mortality was zero and morbidity (4.4%) has been low over time. Mean age at surgery has decreased from 5.9 +/- 3.3 years to 3.6 +/- 3.8 years (p < 0.001); patients requiring blood transfusion decreased from 34% to 4.6% (p < 0.001); and length of hospital stay (LOS) has decreased from 12.1 +/- 2.9 days to 3.8 +/- 2.1 days (p < 0.001). Length of stay for the last 27 patients was 2.8 +/- .8 days. Patient ductus arteriosus recurrence rate is zero with this technique. CONCLUSIONS: Recurrence rates for PTDC are high with as yet unknown consequences of large catheter vascular access, endocarditis, or left pulmonary artery stenosis. Video-assisted thoracotomy for PDA interruption has the potential for uncontrolled exsanguinating hemorrhage. Open thoracotomy for PDA ligation and division can be performed safely and without recurrence through a muscle-sparing incision with short LOS. All other therapeutic interventions must be compared to these standards.

Full text

PDF
402

Images in this article

406Figure 2.
on p.406

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. ASH R., FISCHER D. Manifestations and results of treatment of patent ductus arteriosus in infancy and childhood; an analysis of 138 cases. Pediatrics. 1955 Nov;16(5):695–703. [PubMed] [Google Scholar]
  2. Ali Khan M. A., Mullins C. E., Nihill M. R., al Yousef S., al Oufy S., Abdullah M., al Fagih M. R., Sawyer W. Percutaneous catheter closure of the ductus arteriosus in children and young adults. Am J Cardiol. 1989 Jul 15;64(3):218–221. doi: 10.1016/0002-9149(89)90461-x. [DOI] [PubMed] [Google Scholar]
  3. Betkerur M. V., Yeh T. F., Miller K., Glasser R. J., Pildes R. S. Indomethacin and its effect on renal function and urinary kallikrein excretion in premature infants with patent ductus arteriosus. Pediatrics. 1981 Jul;68(1):99–102. [PubMed] [Google Scholar]
  4. Cifuentes R. F., Olley P. M., Balfe J. W., Radde I. C., Soldin S. J. Indomethacin and renal function in premature infants with persistent patent ductus arteriosus. J Pediatr. 1979 Oct;95(4):583–587. doi: 10.1016/s0022-3476(79)80775-1. [DOI] [PubMed] [Google Scholar]
  5. Clyman R. I., Heymann M. A. Pharmacology of the ductus arteriosus. Pediatr Clin North Am. 1981 Feb;28(1):77–93. doi: 10.1016/s0031-3955(16)33963-3. [DOI] [PubMed] [Google Scholar]
  6. Cohn H. E., Freed M. D., Hellenbrand W. F., Fyler D. C. Complications and mortality associated with cardiac catheterization in infants under one year: a prospective study. Pediatr Cardiol. 1985;6(3):123–131. doi: 10.1007/BF02336550. [DOI] [PubMed] [Google Scholar]
  7. Daniels S. R., Reller M. D., Kaplan S. Recurrence of patency of the ductus arteriosus after surgical ligation in premature infants. Pediatrics. 1984 Jan;73(1):56–58. [PubMed] [Google Scholar]
  8. Edmunds L. H., Jr Operation or indomethacin for the premature ductus. Ann Thorac Surg. 1978 Dec;26(6):586–589. doi: 10.1016/s0003-4975(10)62947-5. [DOI] [PubMed] [Google Scholar]
  9. Egami J., Tada Y., Takagi A., Sato O., Idezuki Y. False aneurysm as a late complication of division of a patent ductus arteriosus. Ann Thorac Surg. 1992 May;53(5):901–902. doi: 10.1016/0003-4975(92)91466-m. [DOI] [PubMed] [Google Scholar]
  10. Fan L. L., Campbell D. N., Clarke D. R., Washington R. L., Fix E. J., White C. W. Paralyzed left vocal cord associated with ligation of patent ductus arteriosus. J Thorac Cardiovasc Surg. 1989 Oct;98(4):611–613. [PubMed] [Google Scholar]
  11. Fleming W. H., Sarafian L. B., Kugler J. D., Nelson R. M., Jr Ligation of patent ductus arteriosus in premature infants: importance of accurate anatomic definition. Pediatrics. 1983 Mar;71(3):373–375. [PubMed] [Google Scholar]
  12. Förster R. Thoracoscopic clipping of patent ductus arteriosus in premature infants. Ann Thorac Surg. 1993 Dec;56(6):1418–1420. doi: 10.1016/0003-4975(93)90703-k. [DOI] [PubMed] [Google Scholar]
  13. GROSS R. E., LONGINO L. A. The patent ductus arteriosus; observations from 412 surgically treated cases. Circulation. 1951 Jan;3(1):125–137. doi: 10.1161/01.cir.3.1.125. [DOI] [PubMed] [Google Scholar]
  14. Gersony W. M., Peckham G. J., Ellison R. C., Miettinen O. S., Nadas A. S. Effects of indomethacin in premature infants with patent ductus arteriosus: results of a national collaborative study. J Pediatr. 1983 Jun;102(6):895–906. doi: 10.1016/s0022-3476(83)80022-5. [DOI] [PubMed] [Google Scholar]
  15. Gray D. T., Fyler D. C., Walker A. M., Weinstein M. C., Chalmers T. C. Clinical outcomes and costs of transcatheter as compared with surgical closure of patent ductus arteriosus. The Patient Ductus Arteriosus Closure Comparative Study Group. N Engl J Med. 1993 Nov 18;329(21):1517–1523. doi: 10.1056/NEJM199311183292101. [DOI] [PubMed] [Google Scholar]
  16. HALLMAN G. L., COOLEY D. A. FALSE AORTIC ANEURYSM FOLLOWING DIVISION AND SUTURE OF A PATENT DUCTUS ARTERIOSUS: SUCCESSFUL EXCISION WITH HYPOTHERMIA. J Cardiovasc Surg (Torino) 1964 Jan-Feb;5:23–28. [PubMed] [Google Scholar]
  17. Heymann M. A., Berman W., Jr, Rudolph A. M., Whitman V. Dilatation of the ductus arteriosus by prostaglandin E1 in aortic arch abnormalities. Circulation. 1979 Jan;59(1):169–173. doi: 10.1161/01.cir.59.1.169. [DOI] [PubMed] [Google Scholar]
  18. Hosking M. C., Benson L. N., Musewe N., Dyck J. D., Freedom R. M. Transcatheter occlusion of the persistently patent ductus arteriosus. Forty-month follow-up and prevalence of residual shunting. Circulation. 1991 Dec;84(6):2313–2317. doi: 10.1161/01.cir.84.6.2313. [DOI] [PubMed] [Google Scholar]
  19. Hosking M. C., Benson L. N., Musewe N., Freedom R. M. Reocclusion for persistent shunting after catheter placement of the Rashkind patent ductus arteriosus occluder. Can J Cardiol. 1989 Oct;5(7):340–342. [PubMed] [Google Scholar]
  20. JONES J. C. TWENTY-FIVE YEARS' EXPERIENCE WITH THE SURGERY OF PATENT DUCTUS ARTERIOSUS. J Thorac Cardiovasc Surg. 1965 Aug;50:149–165. [PubMed] [Google Scholar]
  21. Karwande S. V., Rowles J. R. Simplified muscle-sparing thoracotomy for patent ductus arteriosus ligation in neonates. Ann Thorac Surg. 1992 Jul;54(1):164–165. doi: 10.1016/0003-4975(92)91172-6. [DOI] [PubMed] [Google Scholar]
  22. Laborde F., Noirhomme P., Karam J., Batisse A., Bourel P., Saint Maurice O. A new video-assisted thoracoscopic surgical technique for interruption of patient ductus arteriosus in infants and children. J Thorac Cardiovasc Surg. 1993 Feb;105(2):278–280. [PubMed] [Google Scholar]
  23. Lam C. R. A safe technique for closure of the recurrent patent ductus arteriosus. J Thorac Cardiovasc Surg. 1976 Aug;72(2):232–234. [PubMed] [Google Scholar]
  24. Latson L. A., Hofschire P. J., Kugler J. D., Cheatham J. P., Gumbiner C. H., Danford D. A. Transcatheter closure of patent ductus arteriosus in pediatric patients. J Pediatr. 1989 Oct;115(4):549–553. doi: 10.1016/s0022-3476(89)80279-3. [DOI] [PubMed] [Google Scholar]
  25. Lupinetti F. M., Bove E. L. Invited letter concerning: experience with 205 procedures of transcatheter closure of ductus arteriosus in 182 patients, with special reference to residual shunts and long-term follow-up (J Thorac Cardiovasc Surg 1992;104:1721-7) J Thorac Cardiovasc Surg. 1993 Sep;106(3):567–569. [PubMed] [Google Scholar]
  26. Mavroudis C., Cook L. N., Fleischaker J. W., Nagaraj H. S., Shott R. J., Howe W. R., Gray L. A., Jr Management of patent ductus arteriosus in the premature infant: indomethacin versus ligation. Ann Thorac Surg. 1983 Nov;36(5):561–566. doi: 10.1016/s0003-4975(10)60686-8. [DOI] [PubMed] [Google Scholar]
  27. Musewe N. N., Benson L. N., Smallhorn J. F., Freedom R. M. Two-dimensional echocardiographic and color flow Doppler evaluation of ductal occlusion with the Rashkind prosthesis. Circulation. 1989 Dec;80(6):1706–1710. doi: 10.1161/01.cir.80.6.1706. [DOI] [PubMed] [Google Scholar]
  28. Panagopoulos P. G., Tatooles C. J., Aberdeen E., Waterston D. J., Carter R. E. Patent ductus arteriosus in infants and children. A review of 936 operations (1946-69). Thorax. 1971 Mar;26(2):137–144. doi: 10.1136/thx.26.2.137. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Rashkind W. J., Mullins C. E., Hellenbrand W. E., Tait M. A. Nonsurgical closure of patent ductus arteriosus: clinical application of the Rashkind PDA Occluder System. Circulation. 1987 Mar;75(3):583–592. doi: 10.1161/01.cir.75.3.583. [DOI] [PubMed] [Google Scholar]
  30. SCOTT H. W., Jr Closure of the patent ductus by suture-ligation technique. Surg Gynecol Obstet. 1950 Jan;90(1):91–95. [PubMed] [Google Scholar]
  31. Sørensen K. E., Kristensen B., Hansen O. K. Frequency of occurrence of residual ductal flow after surgical ligation by color-flow mapping. Am J Cardiol. 1991 Mar 15;67(7):653–654. doi: 10.1016/0002-9149(91)90911-4. [DOI] [PubMed] [Google Scholar]
  32. Trippestad A., Efskind L. Patent ductus arteriosus. Surgical treatment of 686 patients. Scand J Thorac Cardiovasc Surg. 1972;6(1):38–42. doi: 10.3109/14017437209134288. [DOI] [PubMed] [Google Scholar]
  33. Tutassaura H., Goldman B., Moes C. A., Mustard W. T. Spontaneous aneurysm of the ductus arteriosus in childhood. J Thorac Cardiovasc Surg. 1969 Feb;57(2):180–184. [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES