Surgical Treatment of Patent Ductus Arteriosus in Preterm and Infants with Severe Heart Failure and Cardiac Cachexia

중증 심부전 또는 심인성 악액질을 동반한 미숙아및 영아기 동맥관개존증에 대한 수술요법

  • Published : 1993.12.01

Abstract

The management of Patent Ductus Arteriosus[PDA] with heart failure and cardiac cachexia in premature infants have been a disturbing and controversial problem in the field of pediatric cardiovascular surgery.We analysed our experiences to determine the rationale of surgical closure of PDA in infants . During a period of 7 years from January 1986 to December 1992, 12 infants under 2 months of age underwent operations for "hemodynamically significant" PDA which had caused severe heart failure.There were 6 male and 6 female patients. Their mean gestational age was 33.8 weeks and their mean body weight was 1990 g. ranged from 710 g. to 2900 g. Mean age at operation was 28.5days. Seven patients had history of Indomethacin trial. All patients were operated with double ligation technique under general anesthesia.There was no mortality and blood transfusion was not necessary in any patient during the operation.In all cases, we could confirm the complete closure of PDA after operation by follow-up echocardiography.Two patients died during their hospital stay and 1 patient died at 6 months after operation. The causes of death were sepsis with congestive heart failure, necrotizing entero colitis and pneumonia respectively.We can not detect any operation related complication which resulted in permanent sequelae as well as delayed complications related to nerve damage. These results indicate that surgical ligation of PDA in infants with severe heart failure is relatively safe and effective.effective.

Keywords

References

  1. Pediatrics v.37 Delyed closure of the ductus arteriosus in premature infants Danilowicz,D.;Rudolph,A.M.;Hoffman,J.I.E.
  2. J. Pediatr. v.69 Delyes closure of the ductus arteriosus Auld,P.A.M.
  3. N. Engl. J. Med. v.287 Patent ductus arteriosus in premature infants. Incidence, relation to pulmonary disease and management Kitterman,J.A.;Edmunds,L.H.Jr;Gregory,G.A.;Heyman,M.A.;Tooley,W.H.;Rudolph,A.M.
  4. J. Pediatr. v.86 Patent ductus arteriosus complicating the respiratory distress syndrom in premature infants Thibeault,D.W.;Emmanouilides,G.C.;Nelson,R.J.;Lachman,R.S.;Rosengart,R.M.
  5. J. Thorac. Cardiovasc. Surg. v.87 Surgical closure of patent ductus arteriosus in 268 preterm infants Henry R.Wagner;Curtis Ellison;Sally Zierler(et al.)
  6. Ann. Thorac. Surg. v.26 Operations or indomethacin for the premature ductus(current review) Edmunds,L.H.Jr
  7. Ann. Thorac. Surg. v.36 Management of patent ductus arteriosus in the premature infant : Indomethacin versus Ligation Constantine Mavroudis;Larry N.Cook;Jennifer W.Fleischaker
  8. J. Pediatr. v.93 Randomized trial of early closure of symptomatic patent ductus arteriosus in small preterm infants Cotton,R.B.;Stahlman,M.T.;Bender,H.W.(et al.)
  9. J. Pediatr. v.93 Improved lung compliance after ligation of patent ductus arteriosus in hyaline membrane disease Naulty,C.M.;Horn,S.;Conry,J.(et al.)
  10. J. Pediatr. v.101 Physiologic changes associated with ligation of the ductus arteriosus in preterm infants Marshall,T.A.;Marshall,F.;Reddy,P.P.
  11. N. Engl. J. Med. v.295 Pharmacologic closure of patent ductus arteriosus in the premature infants Friedman,W.F.;Hirschklau,M.J.;Printz,M.P.(et al.)
  12. N. Engl. J. Med. v.295 Closure of the ductus arteriosus in premature infants by inhibition of prostagrandin synthesis Heymann,M.A.;Rudolph,A.M.;Silverman,N.H.
  13. Surgery of the Chest(5th ed.) Patent ductus arteriosus, Coarctation of aorta, Aortopulmonary window, and Anormalies of the aortic arch Gaynor,J.W.;Sabiston,D.C.Jr;Sabiston,D.C.Jr;Spencer,F.C.
  14. Ann. Thorac. Surg. v.37 A simple, rapid technique for operative closure of patent ductus arteriosus in the preterm infants Kron,I.L.;Mentzer,R.M.Jr;Rheuban,K.S.;Nolan,S.P.
  15. Ann. Thorac. Surg. v.32 Ligation of patent ductus arteriosus in premature infants Brandt,B.Ⅲ;Marvin,W.J.;Ehrenhaft,J.L.(et al.)
  16. Ann. Thorac. Surg. v.29 A simplified method of ligation of patent ductus arteriosus in premature infants Traugott,R.C.;Will,R.J.;Schuchmann,G.F.;Treasure,R.L.
  17. Ann. Thorac. Surg. v.31 Ligation of PDA(correspondence) Kongtahworn,C.;Zeff,R.H.;Beshany,S.E.;Phillips,S.J.
  18. N. Engl. J. Med. v.306 Prophylactic indomethacin therapy for patent ductus arteriosus in very low birth weight infants Mahoney,L.;Carnero,V.;Brett,C.(et al.)
  19. J. Thorac. Cardiovasc. Surg. v.71 Patent ductus arteriosus in premature infants. Indications for surgery Rittenhouse,E.A.;Doty,D.B.;Lauer,R.M.;Ehrenhaft,J.L.
  20. Ann. Thorac. Surg. v.46 Vocal cord paralysis in premature infants undergoing ductal closure Davis,J.T.;Baciewicz,F.A.;Suriyapa,S.;Vauthy,P.;Polamreddy,R.;Barnett,B.
  21. Ann. Thorac. Surg. v.39 Developmental sequelae in premature infants undergoing ligation of patent ductus arteriosus Wickerson,S.A.;Fleischacker,J.;Mavroudis,C.;Cook,L.N.