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J Thorac Cardiovasc Surg 1994;108:383-385
© 1994 Mosby, Inc.

LETTERS TO THE EDITOR

A new clamp for division and suture of patent ductus arteriosus

Service of Cardiac Surgery
La Timone Children's Hospital
Bd Jean Moulin
13385 Marseille, France

To the Editor

A new clamp has been developed for the surgery of patent ductus arteriosus (PDA). Its curvature allows more secure biting of the aortic and pulmonary walls, allowing greater safety during division and suture of PDAs, particularly in the case of short, large PDAs.

This new clamp (Codman & Shurtleff, Inc., Randolph, Mass.) is a modification of the straight (CH 6500) or angled (CH 5602) Potts clamp (V. Mueller, McGaw Park, Ill.) widely used for the division and suture of PDAs. ¹ Once the two clamps are located perpendicular to the aorta, they lie nicely on each side of the operative field and the exposure is optimal (Fig. 1). The concave curvature (Fig. 2) of the clamp's end allows a side-biting of the aorta and the pulmonary artery, rather than just of the PDA itself, allowing adequate tissue for performance of an easy suture after division of the PDA. Like the Potts clamp, the orientation of this clamp allows clamping and suture perpendicular to the direction of the aorta, and this avoids any stenosis at the suture site.

View larger version (42K): [in this window] [in a new window]   Fig. 1. Operative field after placement of clamp and division of PDA. Operative exposure is shown. Aorta is transversely clamped laterally more easily than with a straight clamp.

View larger version (72K): [in this window] [in a new window]   Fig. 2. Proposed clamp with its concave end.

It may seem pretentious to try to improve a technique that in all reports procures excellent results with a negligible morbidity and mortality. In addition, in most occidental and in many other centers the number of patients with PDA referred for surgical treatment is decreasing because of nonsurgical means to close the PDA. ^{2, 3} However, this nonsurgical technique is not applicable in all cases of PDA. It requires an expertise that is not present in all centers, and its overall cost makes surgery preferable in many countries. Therefore it is likely that, worldwide, several hundreds of patients with PDA still undergo and will undergo a surgical procedure.

In a premature or newborn infant or in a patient whose PDA is narrow or long, it is probable that a simple or a double ligation is sufficient. In the majority of cases, however, division and suture is recommended because of the risks of tearing and of repermeation. ^{1, 4} The technique of division and suture is well standardized, present in all textbooks of cardiac surgery. ^{1, 4}

In some cases, however, specific conditions (e.g., large PDA, short PDA, infected PDA, calcified PDA, adult PDA) have prompted surgeons to use alternative techniques, more or less complex: ligation with Teflon felt pledgets, ⁵ transpulmonary closure with cardiopulmonary bypass, ⁶ or transaortic suture with ⁷ or without CPB. ⁴

This clamp is applicable to the most frequent of these special situations—the short and large PDA of the child. In this case, simple straight clamps do not bite enough tissue and placement of side-biting Satinsky clamps is awkward, particularly if one tries to use two clamps.

The clamp that I propose provides a more secure and more generous clamping, as well as comfort and safety. Furthermore, because this operation is most often done by residents or junior surgeons, any added safety and comfort is welcome.

References

1. Kirklin JW, Barratt-Boyes BG. Patent ductus arteriosus. In: Cardiac surgery. New York: John Wiley, 1986:679-97.
   
2. Porstmann W, Wierny L, Warnke H, Gerstberger G, Romaniuk PA. Catheter closure of patent ductus arteriosus: 62 cases treated without thoracotomy. Radiol Clin North Am 1971;9:203.[Medline]
   
3. Rashkind WJ, Cuaso CC. Transcatheter closure of patent ductus arteriosus: successful use in 3-5 kilogram infant. Pediatr Cardiol 1979;1:3.
   
4. Stark J, de Leval M. Surgery of congenital heart defects. New York: Grune & Stratton, 1983:203-11.
   
5. Endman S, Levinsky L, Levy MJ. A simple method for closure of patent ductus arteriosus in elderly patients. Ann Thorac Surg 1979;27:84-5.[Abstract]
   
6. Bahti BS, Nandakumuran CP, Shatapathy P, John S, Cherian G. Closure of patent ductus arteriosus during open-heart surgery: surgical experience with different techniques. J THORAC CARDIOVASC SURG 1972;63:820.[Medline]
   
7. Morrow AG, Clark WD. Closure of the calcified patent ductus: a new operative method utilizing cardiopulmonary bypass. J THORAC CARDIOVASC SURG 1966;51:534.[Medline]
   

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 Author home page(s): Dominique Metras Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Metras, D. Search for Related Content PubMed PubMed Citation Articles by Metras, D.