Ann Thorac Surg 1997;63:178-179
© 1997 The Society of Thoracic Surgeons
Invited Commentary
Invited Commentary
Redmond P. Burke, MD
Division of Cardiovascular Surgery, Miami Children's Hospital, 3200 SW 60th Court, Suite 102, Miami, FL 33155.
See also page 175.
The treatment options for patent ductus arteriosus continue to evolve, and the debate between interventional cardiologists and surgeons as to the best approach rages on. Coil occlusion of small ducts is usually rapid, safe, effective, and minimally traumatic to the patient. Limitations to this technique include the need for fluoroscopic radiation, placement of an intravascular foreign body in a site of turbulent blood flow prone to endocarditis, and difficult seating coils in ducts more than 4 mm in diameter. The video-assisted endoscopic approach has evolved to answer the need for a less traumatic surgical procedure that would measure up to the efficacy of open division, ensuring ductal closure without limitations based on patient size or ductal anatomy.
Pushing the limits reveals the intrinsic weaknesses of any technique. When cardiologists attempted to close larger ducts with coils, the incidence of device embolization increased, as did the failure rate for closure. Chu and colleagues have successfully extended the application of video-assisted duct interruption to patients with large ducts by developing an intracorporeal ligation technique. These results have altered our initial impression that adults and patients with larger ducts might be better suited for interventional device closure or open division, and bring the endoscopic technique closer to the standard set by open ductal division. Surgeons facile with the minimally invasive technique can initially approach any patient with patent ductus endoscopically, converting easily to open division for patients with ductal calcification, pleural scarring, extremely large and short ducts, intravascular devices within the duct, or problems with exposure and hemostasis.
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Video-Assisted Thoracoscopic Operation for Interruption of Patent Ductus Arteriosus in Adults
- Jaw-Ji Chu, Chau-Hsiung Chang, Pyng Jing Lin, Hui-Ping Liu, Feng-Chun Tsai, Delon Wu, Cheng-Wen Chiang, Fen-Chiung Lin, and Peter P.C. Tan
Ann. Thorac. Surg. 1997 63: 175-179.
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