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J Thorac Cardiovasc Surg 1995;110:1681-1685
© 1995 Mosby, Inc.

SURGERY FOR CONGENITAL HEART DISEASE

VIDEO-ASSISTED THORACOSCOPIC SURGICAL INTERRUPTION: THE TECHNIQUE OF CHOICE FOR PATENT DUCTUS ARTERIOSUSRoutine experience in 230 pediatric cases

Brooklyn, N.Y. and Paris, France

From the Department of Cardio-pediatric Surgery, Centre Médico- Chirurgical de la Porte de Choisy, Paris, France.

Address for reprints: Dr F. Laborde. Centre Médico- Chirurgical de la Porte de Choisy, 6 place de Port au Prince, 75013 Paris, France.

Abstract

Video-assisted thoracoscopic surgical interruption for patent ductus arteriosus is a well-standardized procedure already described. We present our entire series of such cases, from the first case (performed on Sept. 5, 1991) to March 1, 1995. Two hundred thirty patients in a variety of age groups underwent video-assisted interruption: younger than 6 months (70 patients, 30%), 6 to 48 months (123 patients, 54%), and older than 48 months (37 patients, 16%). The mean weight was 12.6 kg (range 1.2 to 65 kg). Thirty-nine patients had symptomatic pulmonary hypertension. Associated intracardiac anomalies included atrial septal defect (three), ventricular septal defect (five), and anomalous pulmonary venous return (one). All patients underwent video-assisted interruption of the patent ductus arteriosus with two titanium clips. Closure was evaluated by postoperative echocardiography before extubation. Five patients had a persistent patent ductus after video-assisted interruption, all early in our experience and related to insufficient dissection resulting in inadequate clip placement. Four patients had successful immediate clip repositioning (three by video-assisted interruption and one by thoracotomy). Subsequent echocardiography revealed persistent closure in these patients. A persistent patent ductus arteriosus with minimal flow was discovered in one patient without symptoms after discharge. Recurrent laryngeal nerve dysfunction was noted in six patients (2.6%; five transient and one persistent). There were no deaths, hemorrhages, transfusions required, or chylothoraces in this series. Mean operative time was 20 ±15 minutes, and hospital stay averaged 48 hours for patients younger than 6 months and 72 hours for patients older than 6 months. This is a safe, rapid, cost-effective technique that results in excellent results and a shortened hospital stay. Video-assisted interruption represents the technique of choice for closure of a patent ductus arteriosus. (J THORAC CARDIOVASC SURG 1995;110:1681-5)

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