Closure Of Arterial Duct Research Articles

Effect of Open Heart Surgery with Cardiopulmonary Bypass on Peripheral Blood Lymphocyte Apoptosis in Children

Children undergoing cardiopulmonary bypass (CPB) operations have an increased risk for the development of immunosuppression and severe infection. Lymphocyte apoptosis plays an important role in regulating immune responses. This study aimed to investigate the effect of open heart surgery with CPB on peripheral blood lymphocyte (PBL) apoptosis and the possible mechanism of lymphocyte apoptosis in infants and young children. This study enrolled 20 consecutive infants and children as a CPB group and 20 age-matched children who underwent patent arterial duct closure without CPB as control subjects. Samples were taken from peripheral blood after induction of anesthesia (preoperatively) and again 24 h after the operations. The degree of apoptosis and the expression level of Fas (CD95) on PBL were measured using flow cytometry. The percentage of lymphocyte apoptosis significantly increased after surgery in both groups, but it was much higher in the children with CPB than in those without CPB (14.46%+/-4.83% vs. 7.33%+/-1.43%; p<0.01). The expression level of Fas in the individuals with CPB was significantly higher than in those without CPB (52.80%+/-8.80% vs. 37.82%+/-6.32%; p<0.01). As shown by the study findings, both surgical stress and CPB can induce PBL apoptosis, which may lead to lymphopenia after open heart surgery with CPB for infants and young children.

Congenital cardiac emergencies

Cardiac emergencies are rare in children in comparison to adults. The pathophysiology differs; ischaemic heart disease is virtually unknown, whereas most congenital cardiac emergencies occur secondary to structural heart disease. Of the myriad lesions many decompensate in the perinatal period, usually in association with arterial duct closure. Subsequent rapid haemodynamic deterioration may lead to a moribund infant in extremis at presentation and with more home deliveries and early discharges such infants may present not only to paediatricians, but to accident and emergency departments, GPs and community midwives.

Thoracoscopic closure of the patent arterial duct

Video assisted thoracoscopic surgery for closure of the persistently patent arterial duct is an effective answer to the modern effort of seeking repair of congenital cardiac malformations with minimally invasive techniques. Between June, 1994, and December, 2002, 150 consecutive patients with an echocardiographic diagnosis of isolated patency of the arterial duct were referred to our Institution for video assisted thoracoscopic closure. The median age at the time of operation was 45 months, with a range from 3 to 161 months, and mean weight was 18 kg, with a range from 4.2 to 73 kg. Video assisted closure was possible in 139 patients (93%). The mean operative time was 37 min, with a range from 14 to 89 min. In the remaining 11 patients (7%), seen early in our experience, we converted to a mini-thoracotomy to achieve closure. In no instance did we encounter major haemorrhage requiring blood transfusion, and there were no hospital deaths. The mean period of stay in hospital was less than 24 h in 61 patients, less than 48 h in 88 patients seen earlier in our experience, and 21 days in 1 patient because of a persistent chylothorax. Other complications included palsy of the left recurrent laryngeal nerve in 1 patient, with partial regression at 6 months follow-up. We conclude that closure of the arterial duct by video-assisted thoroscopy combines the advantages of safe and complete extraluminal occlusion with an excellent clinical and aesthetic result, minimal postoperative pain, and short stay in hospital at low cost.

Arterial duct closure with detachable coils: application in the small child.

Transcatheter closure of patent ductus arteriosus using controlled-release coils was performed in 16 patients weighing < 10 kg. No embolization occurred. Procedure-related complications occurred in 3 patients (18.8%): massive femoral hemorrhage in 1 and femoral artery thrombosis in 2. The ductus recanalized in 1 of them because of mechanical hemolysis caused by streptokinase treatment. This was the only patient who underwent another occlusion procedure. Complete occlusion was achieved in 7 patients (43.8%) immediately, in 13 (81.2%) the following day, and in all 15 patients who had completed the 6-month follow-up. During follow-up, flow velocities between the left and the main pulmonary arteries and between the descending and the ascending aortae did not differ significantly. Flow velocity was > 2 m x sec(-1) in 3 patients in the left pulmonary artery and in 1 in the descending aorta. Protrusion of the coil was seen in 3 of these patients. Flow velocity was also high in the main pulmonary artery in the 4th patient. In conclusion, coil occlusion of ductus arteriosus is feasible in the small child, but no more than half a loop of the coil should be left at the pulmonary site. High flow velocity does not always mean obstruction.