Cost-Effectiveness of Transaxillary Muscle-Sparing Same-Day Operative Closure of Patent Ductus Arteriosus

Cetta, Frank; DeLeon, Serafin Y.; Roughneen, Patrick T.; Graham, Lynn C; Lichtenberg, Robert; Bell, Timothy J.; Vitullo, Dolores A.; Fisher, Elizabeth A.

doi:10.1016/s0002-9149(97)00103-3

Cited by 11 publications

(11 citation statements)

References 6 publications

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“…Presently the majority of infants with a large ductus resulting in congestive heart failure or pulmonary hypertension is sent for surgical ligation without an attempt of interventional treatment. Recent innovations like video-thoracoscopic surgical interruption or transaxillary muscle-sparing occlusion have made surgical treatment of patent ductus arteriosus less invasive and therefore much more attractive [7,22,29]. Nevertheless a recent study has shown promising results with the Amplatzer duct occluder even in infants with large ductus arteriosus [24].…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of interventional occlusion of patent ductus arteriosus with detachable coils: a multicentre experience

Hofbeck

Bartolomaeus

Buheitel

et al. 2000

European Journal of Pediatrics

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Section: Discussionmentioning

confidence: 99%

Safety and efficacy of interventional occlusion of patent ductus arteriosus with detachable coils: a multicentre experience

Hofbeck

Bartolomaeus

Buheitel

et al. 2000

European Journal of Pediatrics

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“…84 -86 Important complications include bleeding, pneumothorax, infection, and rarely, ligation of the left pulmonary artery or aorta. Surgical morbidity, cost, and hospital length of stay have been decreased with use of transaxillary muscle-sparing thoracotomy 87,88 and by the technique of video-assisted thoracoscopic ligation of the PDA. 89 …”

Section: Surgical Therapymentioning

confidence: 99%

Patent Ductus Arteriosus

2006

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T he patent ductus arteriosus (PDA) is a vascular structure that connects the proximal descending aorta to the roof of the main pulmonary artery near the origin of the left branch pulmonary artery. This essential fetal structure normally closes spontaneously after birth. After the first few weeks of life, persistence of ductal patency is abnormal. The physiological impact and clinical significance of the PDA depend largely on its size and the underlying cardiovascular status of the patient. The PDA may be "silent" (not evident clinically but diagnosed incidentally by echocardiography done for a different reason), small, moderate, or large. Regardless of the size, complications may arise, and it is important for both pediatric and adult cardiologists to have an understanding of the pathophysiology, clinical implications, and management of PDA. EmbryologyThe ductus arteriosus is a normal and essential fetal structure that becomes abnormal if it remains patent after the neonatal period. In normal cardiovascular development, the proximal portions of the sixth pair of embryonic aortic arches persist as the proximal branch pulmonary arteries, and the distal portion of the left sixth arch persists as the ductus arteriosus, connecting the left pulmonary artery with the left dorsal aorta (Figure 1). Normally, the distal right sixth aortic arch loses its connection to the dorsal aorta and degenerates. This transformation is complete by 8 weeks of fetal life. Normal Physiology Fetal CirculationWhereas Ϸ65% of the fetal cardiac output is from the right ventricle, only 5% to 10% passes through the lungs. 1,2 The preponderance of right ventricular output passes through the ductus arteriosus into the descending aorta. The fetal ductus arteriosus is thus an important structure that is essential for normal fetal development, permitting right ventricular output to be diverted away from the high-resistance pulmonary circulation. Premature constriction or closure may lead to right heart failure, resulting in fetal hydrops. 3 Histology and Mechanisms of Normal ClosureGrossly, the constitution of the fetal ductus arteriosus appears to be similar to the contiguous main pulmonary artery and descending aorta; there are important histological differences, however. 4 -9 Whereas the mediae of surrounding aorta and pulmonary artery are composed mainly of circumferentially arranged layers of elastic fibers, the media of the ductus arteriosus is composed of longitudinally and spirally arranged layers of smooth muscle fibers within loose, concentric layers of elastic tissue. The intima of the ductus arteriosus is thickened and irregular, with abundant mucoid material, sometimes referred to as intimal cushions.Fetal patency of the ductus arteriosus is controlled by many factors, the most important of which are relatively low fetal oxygen tension 10 and cyclooxygenase-mediated products of arachidonic acid metabolism (primarily prostaglandin [PGE 2 ] and prostacyclin [PGI 2 ]). 11 Locally produced and circulating PGE 2 and PGI 2 in the fetus cau...

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“…This incision also has the advantages of minimal anatomic disturbance and trauma to the major chestwall muscles, and hence is likely to be associated with less postoperative pain and, possibly, improved pulmonary function. A plea for routine use of a musclesparing incision for thoracotomy procedures in the pediatric age group is thus justifiable 3,20 .…”

Section: Discussionmentioning

confidence: 99%

“…The first description of trans-axillary thoracotomy for closure of patent ductus arteriosus was by Denis Browne in 1952 3 . The purpose of this retrospective study at our center is to review our experiences, clinical efficacy and compare this with other treatment modalities.…”

Section: Introductionmentioning

confidence: 99%

Clinical outcomes and experiences with trans-axillary surgical ligation of patent ductus arteriosus

Darbari¹,

Chandra²,

Gupta³

et al. 2007

Indian J Thorac Cardiovasc Surg

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Cost-Effectiveness of Transaxillary Muscle-Sparing Same-Day Operative Closure of Patent Ductus Arteriosus

Cited by 11 publications

References 6 publications

Safety and efficacy of interventional occlusion of patent ductus arteriosus with detachable coils: a multicentre experience

Safety and efficacy of interventional occlusion of patent ductus arteriosus with detachable coils: a multicentre experience

Patent Ductus Arteriosus

Clinical outcomes and experiences with trans-axillary surgical ligation of patent ductus arteriosus

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