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Ann Thorac Surg 2007;83:2228-2230
© 2007 The Society of Thoracic Surgeons

Case Reports

Patent Ductus Arteriosus Ligation: The LigaSure System May Be Unreliable

Corina R. Zamfir, MDa, Magali Vernet, MDb, Mathilde Funes de la Vega, MDc, Emmanuel Sapin, MDa,*

a Department of Paediatric Surgery, Paediatric Hospital–CHU de Dijon–Université de Dijon-Bourgogne, Dijon, France
b Department of Anaesthesiology, Paediatric Hospital–CHU de Dijon–Université de Dijon-Bourgogne, Dijon, France
c Department of Pathology, Paediatric Hospital–CHU de Dijon–Université de Dijon-Bourgogne, Dijon, France

Accepted for publication December 27, 2006.

* Address correspondence to Dr Sapin, Service de Chirurgie Pediatrique, CHU de Dijon, 10, Bd Mal de Lattre de Tassigny-B.P.77, Dijon Cedex, 908-21079, France (Email: emmanuel.sapin{at}chu-dijon.fr).

Surgical ligation of a patent ductus arteriosus (PDA) in small premature infants may be performed with open thoracotomy or video-assisted thoracoscopic surgery (VATS). The LigaSure vessel sealing system (Valleylab/Tyco Healthcare, Boulder, CO) is increasingly being used because of its effectiveness in promoting coagulation. Moreover, for PDA ligation using VATS, the LigaSure system seems more practical than vascular clips. Among 81 children, including 43 premature infants weighing less than 1000 grams operated on for PDA in our institution, one 9-month-old boy weighing 7600 grams underwent PDA ligation using a LigaSure grasp. The perioperative aspect of the closed ductus was satisfactory. The following day, however, ultrasound control revealed recanalization of the ductus, and the child had to undergo a second operation. At operation, the ductus wall adventia and media appeared to have retracted to both extremities, leaving the intima exposed and pulsating under the blood pressure. The PDA ligation was repeated, but in conditions of severe hemorrhage. The LigaSure system works by fusing collagen in the tissue. However, because the ductus wall has less collagen than any other vessels in the body, the LigaSure vessel sealing system is not reliable for PDA ligation.






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