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J Thorac Cardiovasc Surg 1994;107:1159-1160
© 1994 Mosby, Inc.

LETTERS TO THE EDITOR

Patent ductus arteriosus open for clipping?

Thorax-, Herz- und Gefäßchirurgie der
Westfälische Wilhelms-Universität
Albert Schweitzer Str. 33
4400 Münster, Germany

To the Editor:

The technique of clipping the patent ductus arteriosus (PDA) has been described and used in premature infants. The average weight of preterm infants that need closure of the PDA is around 1200 gm; more than 40% weigh less than 1000 gm. ¹ It is believed that in older children and adults the PDA has to be transected to guarantee permanent closure. ² Laborde and coworkers, in the February 1993 issueof this JOURNAL(1993;105:278-80), demonstrated the feasibility of thoracoscopic clipping of the PDA in children with an average weight of 9.5 kg (2.4 to 25 kg). The group states that the new method is not currently applicable to smaller infants but with new instruments propably will be applicable in future.

Thoracoscopic clipping of the PDA has been performed at our institution since January 1993. So far we have treated three premature infants (750, 900, and 1000 gm). The operating time, as for the open procedure, is not longer than 20 minutes. No intraoperative complications occurred and the postoperative course so far in all three children has been uneventful. The technique and all instruments that we use were developed and tested in an animal trial conducted in 1992.

Until now we have not used the technique in children weighing more than 2 kg because we fear that the technique would increase the rate of recanalization of the PDA. We would greatly appreciate hearing a discussion of this matter. Will there be a higher rate of recanalization when the PDA in children weighing more than 2 kg is clipped? If so, will the benefit of minimal invasive treatment outweigh this disadvantage? Should thoracoscopic ligation be used in these patients or must transection be used?

References

1. Wilkerson SA, Fleischaker J, Mavroudis BAC, Cook LN. Developmental sequelae in premature infants undergoing ligation of patent ductus arteriosus. Ann Thorac Surg 1985;39:541-6.[Abstract]
   
2. Körfer R. Aorta und Ductus Botalli persistens einschl. Schlingenbildung der A. pulmonalis in Herzchirurgie. Borst HG, Klinner W, Oelert H, eds. Berlin: Springer Verlag, 1991:315-38.
   

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Förster, R. Articles by Scheld, H. H. Search for Related Content PubMed PubMed Citation Articles by Förster, R. Articles by Scheld, H. H.