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

LETTERS TO THE EDITOR

Patent ductus arteriosus open for clipping?

Francois Laborde, MD

Centre Medico-Chirurgical de la Porte de Choisy
Service de Chirurgie Cardiovasculaire
6, Place de Port-au-Prince
75013 Paris, France

Reply to the Editor:

I would like to congratulate Drs. Förster and Scheld because they successfully treated preterm infants smaller than those whom we treated. I especially commend them because they trusted the technique we described. So long as a technique is used by only one team or one person it has not become normal practice. If the number of followers increases, this new development will indicate that this technique is helpful, modern, and safe and so can be discussed, evaluated, and thereby make progress.

Our experience in this field now comprises more than 160 patients in the same age and weight ranges that we mentioned (age 24 months, ranging from 1 month to 17 years; weight 11 kg, ranging from 1.9 to 45 kg).

We restricted this technique to children and teenagers. All patients were regularly checked by Doppler echocardiography, and we never observed any recanalization or change in the clip position. None of these patients had hemorrhagic or any other major complications. We would insist on the importance of dissecting the entire ductus thoroughly on each side, which avoids damage to the recurrent nerve and allows two long enough clips, occluding the ductus totally and permanently, to be applied.

Because of the high risk of incomplete ligation, already well documented with the classic approach, thoracoscopic ligation is unwise. Thoracoscopic transection is also to be avoided because of the risk of hemorrhage, and it is not as useful as clipping.

I would comment on one other application of this technique which requires transection of a fibrous ligament in case of a vascular ring with esophagotracheal compression. Our experience is one case. After sectioning the ligament, the opened ring must be dissected widely to avoid the deleterious compressive effects.





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