Patent Ductus Arteriosus: An Analysis of 515 Surgically Proved Cases

Abstract

SUMMARY AND CONCLUSIONS During the years 1938 to 1958, 435 patients with isolated patent ductus arteriosus and 80 patients with additional cardiac lesions have been operated on at the University of Minnesota Hospitals. The vast majority of patients over one year of age were described as having a machinery-like murmur and a thrill maximal in the second and third left intercostal spaces. During infancy, however, the clinical picture was frequently indistinguishable from that of a ventricular septal defect. Accordingly, special diagnostic procedures were more frequently employed during infancy. Cardiac catheterization and retrograde aortograms were equally successful as a means of obtaining correct diagnoses. Mean pulmonary artery pressures correlated reasonably well with the type of murmur and electrocardiographic patterns. Ligation of the ductus was employed in only 7 per cent of the cases. In the remainder of the cases the ductus was transected. There were ten deaths (2.3 per cent) mortality rate in isolated patent ductus. Nine patients had definite episodes of subacute bacterial endocarditis prior to surgery. One of them died as a result of the tearing of the fragile ductus during surgery. The remaining cases underwent uneventful surgical corrections. Pregnancy, a previous history of rheumatic fever, maternal rubella, or the presence of non-cardiac congenital anomalies did not significantly affect the surgical outcome. Even more surprising was the fact that the operation during infancy did not adversely affect the surgical mortality. Only three patients were thought to have excessive postoperative bleeding in spite of a high incidence of abnormal blood coagulation tests. None of the 61 patients with frequent epistaxis, menorrhagia, or hemoptysis had excessive postoperative bleeding. The operative mortality rate for males was double that for females. The trend at this center has been toward earlier surgery, usually as soon as a definite diagnosis has been established. Patients who are diagnosed in early infancy and who are otherwise normal may be watched for a few months.