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  • Title: Closure of a large patent ductus arteriosus in children and adults with pulmonary hypertension.
    Author: Kalavrouziotis G, Kourtesis A, Paphitis C, Azariades P.
    Journal: Hellenic J Cardiol; 2010; 51(1):15-8. PubMed ID: 20118039.
    Abstract:
    INTRODUCTION: Surgical closure of a patent ductus arteriosus (PDA) in cases with pulmonary hypertension, a short and wide PDA, and/or calcification of the wall of the vessel can be a hazardous procedure. The use of extracorporeal circulation provides the necessary safety for effective closure. METHODS: Four patients (one male), aged 7, 22, 54 and 60 years old, underwent PDA closure. All had pulmonary hypertension (pulmonary artery pressure, PAP 55-85 mmHg, PAP-to-systemic pressure ratio 0.6-0.8) and a wide, short PDA (diameter 9-12 mm) with a calcified wall in 2 cases. The surgical technique involved transpulmonary PDA closure with a synthetic patch under extracorporeal circulation and mild hypothermia (n=2); or double ligation and purse-string suture of the PDA with extracorporeal circulation and normothermia on a beating heart (n=1), or with heart-lung machine on standby (n=1). RESULTS: Mortality was nil. The postoperative course was mild in all cases. Follow up 3 to 8 years post surgery showed effective PDA closure, PAP within normal (n=3) or at upper normal limits (n=1), and no other sequelae. CONCLUSIONS: The use of extracorporeal circulation allows safe and uncomplicated surgical closure of a PDA in "difficult" cases.
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