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The Journal of Thoracic and Cardiovascular Surgery, Vol 105, 278-280, Copyright © 1993 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
F Laborde, P Noirhomme, J Karam, A Batisse, P Bourel and O Saint Maurice
Classic surgical interruption of patent ductus arteriosus was partially
replaced by transcatheter endovascular closure in 1971. We describe a new
technique for ductus closure by video-assisted thoracoscopic surgical
interruption, derived from video-assisted endoscopic surgery. With the
patient under general anesthesia and intubated, two 5 mm holes were made
through the left thoracic wall. A video camera and specially devised
surgical tools were introduced; such as scissors, dissectors, and clip
appliers. The ductus was dissected, and two titanium clips were applied,
completely interrupting the ductus. Thirty-eight patients were operated on
from April 1991 to April 1992. Mean age was 23.3 months (range 1.5 to 90
months) and mean weight was 9.5 kg (range 2.4 to 25 kg). Six had associated
lesions not necessitating immediate surgical treatment. All had successful
closure of the patent ductus with the video-assisted technique, but two
needed two such procedures, one because of incomplete immediate ductus
closure and one because of partial opening of the clip after 24 hours. One
patient had recurrent laryngeal nerve injury and four had pneumothorax on
the left side. The usual hospital stay was 2 or 3 days. There were no other
complications and no deaths. Video-assisted thoracoscopic surgical
interruption was a rapid, safe, and successful technique for closure of the
patent ductus arteriosus. Better dissection of the ductus decreased the
risk of recurrent laryngeal nerve injury and that of clip opening. In the
last 26 patients, in whom a 2 mm multiperforated catheter was used for
chest drainage during the first hours, no pneumothoraces occurred. Video-
assisted thoracoscopic interruption of the patent ductus arteriosus is
feasible in low-weight infants, whereas transcatheter endovascular closure
of the ductus usually is not possible. The technique will be applied to
premature infants with new instruments designed for the size of these
patients.
ARTICLES
A new video-assisted thoracoscopic surgical technique for interruption of patient ductus arteriosus in infants and children
Service de Chirurgie Cardio-vasculaire, Centre Medico Chirurgical de la Porte de Choisy, Paris, France.
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