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Ann Thorac Surg 2005;80:1976
© 2005 The Society of Thoracic Surgeons

Correspondence

PDA Ligation: Trans or Extrapleural Approach

Sameh Ibrahim Sersar, MD a , Hytham Abdel Mooty, MBBCH a , Muna Mohammed Hafez, MD a , Mohammed Fouad Ismail, MS a , Amal A. Refaat, MD b , Mohammed F. Ibrahim, FRCS b

a Departments of Cardiothoracic Surgery and Pediatric Cardiology Mansoura University Mansoura, 35516 Egypt
b King Fahd Medical City, Riyadh, KSA

(Email: sameh001{at}yahoo.com).

To the Editor:

I read with interest the article, "Modified Extrapleural Ligation of Patent Ductus Arteriosus: A Convenient Surgical Approach in a Developing Country" [1]. I have a few comments. First, their intercostal incision is low (in relation to the 5th rib). It is known that either the 3rd or 4th space is best. We usually interrupt the left superior intercostal vein and not the left hemiazygos as they mentioned. They chose interventional cardiology as a method of choice depending on the diameter of the patent ductus arteriosus (PDA), which is not as important as its length. The main challenges during PDA ligation are calcified PDA and short window type PDA in which it is difficult to find a site for the placement of the ligatures [2].

Their recommendation to put a titanium clip in between the two ligatures is ideal but not always feasible. Extrapleural PDA ligation may give a false sense of security in regard to the postoperative bleeding, whereas the presence of the intercostal tube in cases of transpleural PDA ligation is a good monitor for postoperative bleeding, which is a great concern. I do not agree with the authors in their belief that late complications reported after a conventional surgical transpleural technique such as scoliosis, a winged scapula, chest wall deformities, breast disfigurement, and rib fusion with secondary respiratory compromise are lessened with the extrapleural approach. I do think that they are equal.

Currently, transcatheter closure of the PDA is recommended for PDA of 3 mm or less in diameter and is considered by the family as a vaiable option to surgery when the PDA is long and as great as 8 to 10 mm in diameter [3].


   References
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 References
 

  1. Leon-Wyss J, Vida VL, Veras O, et al. Modified extrapleural ligation of patent ductus arteriosusa convenient surgical approach in a developing country. Ann Thorac Surg 2005;79:632-635.[Abstract/Free Full Text]
  2. Rothman A, Gruberg L, Adelmann G. Congenital heart diseases, cardiac catheterization. In: Weissman N, Adelmann G, eds. Cardiac Imaging Secrets. Hanley and Belfus 2004;301.
  3. Haas G. Patent ductus arteriosus and aortopulmonary window. In: Baue A, Geha A, Hammond G, Laks H, Naunheim K, eds. Glenn's Thoracic and Cardiovascular Surgery, 6th ed. Appleton & Lange, 1996:1137..



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Ann. Thorac. Surg., November 1, 2005; 80(5): 1976 - 1977.
[Full Text] [PDF]

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