Ann Thorac Surg 2006;82:769
© 2006 The Society of Thoracic Surgeons
Correspondence
Approach to Patent Ductus Arteriosus
Balamurali Srinivasan, MCh,
Shyam Kumar Thingnam, MCh,
Debasis Das, MS, MCh,
Harkant Singh, MCh
Department of CTVS, PGIMER, Chandigarh 160012, India
(Email: eazzyryder{at}yahoo.com).
To the Editor:
We read with interest Dr Sersar and colleagues' [1] correspondence and the article by Leon-Wyss and co-authors [2] that prompted it. Both these authors have not acknowledged the presence of other minimally invasive surgical approaches to patent ductus arteriosus (PDA), the transaxillary route in particular, which is both transpleural and minimally invasive.
Our own approach to PDA has been through the transaxillary route since February 2004. The PDA interruption has been carried out successfully through this approach in 46 patients with a wide range of age (27 days to 23 years) and weight (1.8 to 35 kg). Thirty-eight patients (82.6%) were discharged on the first postoperative day. Only 2 patients required intercostal tube placement for pneumothorax postoperatively. Only 1 patient was found to have a residual PDA in the routine postoperative echocardiographic examination. In our experience we found the transaxillary route to be a viable and safe alternative to the traditional posterolateral approach. Its advantages are better cosmesis (Fig 1), less operative time, and early discharge from the hospital.
Other minimally invasive surgical approaches to PDA include the anterior extrapleural approach and the transverse cervicotomy approach by Mazzera and colleagues [3] and Villa and coauthors [4], respectively, and the dorsal minithoracotomy approach by Vicente and colleagues [5].
In the treatment of PDA with mortality rate approaching zero [6], the emphasis is currently on cost effectiveness and decreasing morbidity. All these minimally invasive approaches aim to decrease costs and morbidity, and are especially relevant in a setting in which expertise and equipment for percutaneous techniques and video-assisted surgery are lacking. However, until such time as controlled trials establish the superiority of one of these approaches as opposed to the other approaches, the ideal minimally invasive surgical approach to PDA will continue to be debated.
 |
References
|
|---|
- Sersar SI, Mooty HA, Hafez MM, Ismail MF, Refaat AA, Ibrahim MF. PDA ligationtrans or extrapleural approach. Ann Thorac Surg 2005;80:1976.[Free Full Text]
- 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]
- Mazzera E, Brancaccio G, Feltri C, Michielon G, Di Donato R. Minimally invasive surgical closure of patent ductus arteriosus in premature infantsa novel approach. J Card Surg 2002;17:292-294.[Medline]
- Villa E, Mazzera E, Galetta D, Di Donato RM. Patent ductus arteriosus in neonates and new approaches Ann Thorac Surg 2005;79:1827-1828.[Free Full Text]
- Vicente WV, Rodrigues AJ, Ribeiro PJ, et al. Dorsal minithoracotomy for ductus arteriosus clip closure in premature neonates Ann Thorac Surg 2004;77:1105-1106.[Abstract/Free Full Text]
- Mavroudis C, Backer CL, Gevitz M. Forty six years of patent ductus arteriosus division at Children's Memorial Hospital of Chicagostandards for comparison. Ann Surg 1994;220:402-410.[Medline]
Top
References
