PDA Ligation: Trans or Extrapleural Approach

Sersar, Sameh Ibrahim; Mooty, Hytham Abdel; Hafez, Muna Mohammed; Ismail, Mohamed; Refaat, Amal A.; Ibrahim, Mohammed

doi:10.1016/j.athoracsur.2005.03.009

Cited by 6 publications

(3 citation statements)

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…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].…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Uysal

Tekin

Dogan

2021

HSF

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Background: The aim of this study was to present an extrapleural approach for the closure of patent ductus arteriosus (PDA), with the repair of aortic coarctation (CoA) in the same session, in critically ill newborns and infants as an alternative to the transpleural surgical technique. Methods: Between December 2007 and November 2010, 44 critically ill patients with PDA and coarctation of the aorta were operated on during the same session with the extrapleural approach. The diagnoses of the patients were made by transthoracic echocardiography (TTE). We investigated the aortic arch, the length of the coarctation segment, peak-to-peak gradients, the aortic valve, and intracardiac defects prior to the surgery using TTE. Cardiac angiography was performed to determine whether the patients were suitable for an interventional approach in hemodynamically stable patients. Twenty-eight patients had congestive heart failure with mild to moderate pulmonary and systemic hypertension. The median gestational age and weight of neonates were 2.1 kg (range: 1.4 to 2.9 kg), and 31.4 weeks (range, 28.6 to 37 weeks), respectively. During the operations, PDA was closed using double clips. Resection of coarctation with an extended end-to-end anastomosis was performed in 27 patients. Subclavian flap angioplasty was performed in four patients, and an aortic patch repair was performed in two infants. Postoperative PDA flow and residual aortic gradient were evaluated using echocardiography prior to discharge from the hospital and during the follow-up period. Results: There were three in-hospital deaths (6.8%). During the follow-up period, two patients died (4.8%). The mean follow-up period was 48.3±21.5 months (range: 29-56 months). Patent foramen ovale, atrial septal defect, and ventricular septal defect were the additional cardiac pathologies. These were hemodynamically insignificant. We detected that the intracardiac defects closed spontaneously. During the follow-up period, recoarctation developed in six patients (20%). We found that the risk factors for recoarctation in patients were to have a gradient from coarctation area, which was higher than ≥ 50 mmHg, and the length of coarctation segment that was longer than 1 cm in their first operation (P = 0.033). The median time from the first surgery to recoarctation was 25.4±13.2 months (range: 16-36 months). Balloon dilatation was performed in four patients. We performed redo-surgery in the remaining two patients with recoarctation. The mean intubation time was 9.1±13.4 hours (range: 5.8-19.8 hours). Transthoracic echocardiography showed normal left ventricular dimensions and systolic function in 34 patients during follow up (87.1%). Conclusion: Our experiences show that surgical repair of aortic coarctation and PDA closure at the same session may be performed safely and with acceptable mortality and morbidity via an extrapleural approach. Interventional approach as a less invasive method may be used in patients who have developed recoarctation.

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