Extrapleural Closure of Patent Ductus Arteriosus: How We Do It

Abstract

Patent ductus arteriosus (PDA) is a clinical condition mostly found in premature newborns. Among several medical, surgical and interventional treatment options, extrapleural ligation through a left minithoracotomy is recognized as a safe, efficient and less expensive technique. In fact, it requires short surgical times, grants good exposure of the duct and nearby structures ( e.g. , thoracic duct, left recurrent laryngeal nerve), and avoids pleural space opening and subsequent pulmonary complications in preterm patients. This approach seems ideal due to its lower costs, especially in developing countries with a high birth rate and limited resources.

Evaluation of Cardiac Function Characteristics after Patent Ductus Arteriosus Closure in Children and Adults by Echocardiographic Data

“…The second sound of the pulmonary valve is hyperactive, but it is often obscured by loud murmurs. In patients with larger shunt volume, diastolic murmur due to relative mitral stenosis can be heard in the apical region [7,8]. Blood pressure measurement showed that systolic blood pressure was mostly in the normal range, while diastolic blood pressure was decreased, so pulse pressure was widened, and limb blood vessels have water pulse and shooting sound.…”

Large patent ductus arteriosus in a 14-month-old girl with low birth weight

“…Surgical ligation uses titanium clamps; early surgical ligation minimizes the side effects of HS PDA and is more commonly used in low birth weight premature infants (7). The method of extrapleural surgical plasty of PDA is inexpensive and effective, with good cosmetic results, and is also more often used in premature infants (8). Gianturco coils have been used for small to medium diameter PDA with good postoperative results.…”

Clinical Outcomes of Extrapleural Closure of a Patent Ductus Arteriosus Concomitant with Aortic Coarctation Repair

“…Since it has some complications, such as pleural effusion or phrenic nerve damage, an extrapleural or video-assisted minimally invasive surgery have been described for the closure of PDA in critically ill patients [Früh 2011;Wyss 2005;Mazzera 2002;Vicente 2004;Iwase 2003;Leon-Wyss 2003;Pradegan 2020;Sersar 2005;Demirturk 2011;Chen 2011;Villa 2004]. No report has been published concerning PDA closure in combination with coarctation repair in the same session using an extrapleural technique in neonates or infants with congestive heart failure.…”

“…With surgical experiences and technological advancement, successful trans-and extrapleural or minimally invasive (endoscopic) surgical approaches may prevent late complications such as scoliosis, winged scapula, chest wall deformities, breast malformation, and rib fusion after the transpleural technique, which also may cause secondary respiratory compromise. The advantage of an extrapleural technique has been described in a limited number of patients [Wyss 2005;Mazzera 2002;Vicente 2004;Iwase 2003;Leon-Wyss 2003;Pradegan 2020;Sersar 2005;Demirturk 2011].…”

“…This classical technique may increase the risk of bleeding, pneumothorax, hemothorax, or chylothorax as lifethreatening complications that may require revision surgery or longer intubation time after surgery. In order to prevent complications of transpleural technique during an isolated PDA closure procedure, a minimally invasive extrapleural approach or video-assisted thoracoscopy previously has been described in a limited number of reports [Früh 2011;Wyss 2005;Mazzera 2002;Vicente 2004;Iwase 2003;Leon-Wyss 2003;Pradegan 2020;Sersar 2005]. In our study, we present coarctation repair in combination with PDA closure in the same session using an extrapleural approach in critically ill children.…”