Surgical Closure of the Patent Ductus Arteriosus in Premature Infants by Axillary Minithoracotomy

Cho, Jung Soo; Baek, Wan Ki; Yoon, Yong Han; Kim, Joung Taek; Kim, Kwang Ho; Hong, Yung Jin; Jun, Yong Hoon; Shinn, Helen Ki

Abstract

BACKGROUND: Closure of the ductus arteriosus is often delayed in premature infants, which creates a hemodynamically significant left to right shunt that exerts an adverse effect on the normal development and growth of these babies. We reviewed our experience on surgical closure of patent ductus arteriosus via axillary minithoracotomy in premature infants. MATERIAL AND METHOD: From April 2002 to October 2006, 20 premature infants whose gestation was under 37 weeks underwent surgical closure of patent ductus arteriosus as a result of complications or contraindications for the use of indomethacin. Their mean gestational age was 28.8+3.4 weeks, ranging from 25+3 to 34+6 weeks, and the average age at operation was 15.6+/-6.3 days. The mean body weight at operation was 1,174+/-416 g, ranging from 680 to 2,100 g; 16 infants were under 1,500 and 9 infants were under 1,000 g. The procedures were performed in the newborn intensive care unit via 2~3 cm long axillary minithoracotomy with the infant in the lateral position with left arm abduction. The mean size of the patent ductus arteriosus was 3.8+/-0.3 mm. For the most part, the ductus was closed with clips; 2 infants in whom the ductus was ruptured while dissection was being performed underwent ductal division. RESULT: Ten of twelve infants who had been ventilator dependent preoperatively could be successfully weaned from the ventilator at a mean duration of 9.7 days after the operation. There was no procedure-related complication or death. Two infants eventually died of the conditions not related to the operation; one from sepsis at postoperative 131 days and the other from pneumonia at postoperative 41 days, respectively.
CONCLUSION
Surgical closure of the patent ductus arteriosus improved the hemodynamic instability and so promoted the successful growth and normal development of premature infants. Considering the low surgical risk along with the reduced invasiveness, early and aggressive surgical intervention is highly recommended.