2005, Number 1
Surgical treatment of Persistent ductus arterious Twenty-one years experience in a general hospital
Staines-Orozco H, Fuentes-Torres MA, Staines-Alarcón R
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Language: Spanish
References: 13
Page: 39-45
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ABSTRACT
Introduction: Ductus arteriosus is the distal part of the sixth left aortic arch that in the foetus conducts the blood flow of the pulmonary artery to the aorta, bypassing lungs. As soon as respiration is begun, pulmonary resistances drop abruptly, reversing the direction of blood flow. Hence, as oxygen level rises in arterial blood, the closure of ductus arteriosus is produced. When this fails, it originates a pathology called patent ductus arteriosus (PDA) that represents the second cause of acyanotic congenital cardiopathies whose surgical treatment we will analyze in this paper.Material and methodology: A multi-centric study of a retrospective analysis of 26 clinical records of children surgical intervened for PDA from which most relevant data were reviewed as: age, sex, nutritional status, physical activity, cardiac insufficiency episodes and respiratory infections, besides radiology reports, cardiac x rays, cardiac catheterism, ECG, echocardiography, Colour Echo Doppler, surgical technique used and complications.
Results: During 1982 and 2003 period, 26 patients were intervened in second level hospitals, 57% were females. In the first years (1981-1983) PDA was corroborated by cardiac catheterism in five patients, the rest was diagnosed by echocardiography and Doppler. Surgical procedure was section and suture of PDA in 22 patients, and in four of them triple ligature was performed. In twenty five surgical approach was left posterolateral thorachostomy, (fifteen transpleural, ten retropleural) and one by means of thorachoscopy. In the fifteen patients with transpleural approach, the mean surgical time was four hours with hospital stay of 11.8 days. Retropleural approach mean surgical time was 3.3 hours with 9.5 days of hospitalization. The patient with thorachoscopy the surgical time was 4.30 hours. In this patient an in those with retropleural approach there were no complications. In transpleural approached patients complications seen had no relation with the type of surgery.
Conclusions: In our environment, index of suspicion for PDA is low, official institutions continue to centralize its treatment in first level hospitals; this causes delay in management and cost increments. We recommend that treatment of PDA be made in second level hospitals, by retropleural approach, since in our study surgical time and length of hospital stay was shorter and there were no complications
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