Patient Ductus Arteriosus Research Articles

Device closure of patent ductus arteriosus: optimal guidance by transaortic phased-array imaging

In many institutions, device closure of patent ductus arteriosus (PDA) in adult patients is only performed once to twice per year. This report describes an interventional PDA closure procedure being effectively assisted by transaortic phased-array imaging, also known as intracardiac echocardiography (ICE). This way, well-known advantages of ICE as are lowering of radiation exposure and fluoroscopy time can potentially be transferred to PDA device closure.

Unsuccessful Percutaneous Transcatheter Occlusion of A Patent Ductus Arteriosus and Surgical Treatment

The traditional percutaneous transcatheter approach is not ideal in closing some types of patent ductus arteriosus due to morphological abnormalities. The anatomic changes of the patent ductus arteriosus in adult patients, such as being short or sometimes friable, could complicate its transcatheter occlusion. In this study, we reported successful surgical closure of our case with patent ductus arteriosus of abnormal morphology under the light of literature who underwent an unsuccessful attempt of transcatheter occlusion.

Relation of Limiting Ductal Patency to Survival in Neonatal Ebstein’s Anomaly

Fetal and neonatal Ebstein's anomaly has a poor prognosis, and there are few contemporary reviews of management and outcomes. This study retrospectively reviewed a management algorithm promoting early ductal closure after anatomic pulmonary obstruction had been excluded or relieved in neonatal Ebstein's anomaly from 1995 to 2004. Twenty-eight patients with Ebstein's anomaly were identified, 9 prenatally (8 with hydrops) and 19 postnatally, at a median age of <24 hours. Celermajer index scores predicted a mortality rate of 35%. Prostaglandins were administered to 24 of 28 patients. Prostaglandins were continued for obstructive lesions in 9 until the relief of pulmonary outflow obstructions or aortic coarctation repair. In 8 of 9 patients, prostaglandins were discontinued after intervention. One patient continued receiving prostaglandins until a Blalock-Taussig shunt was performed 3 weeks after surgical valvotomy. Prostaglandins were discontinued in 17 of 24 patients with uneventful ductal constrictions. The ductus arteriosus persisted in 5 patients with hemodynamic instability, of whom 4 underwent ductal ligation, with immediate improvement. In 1 of 24 patients, unrecognized right ventricular outflow tract obstructions became apparent when prostaglandins were discontinued. Prostaglandins were restarted until a primary superior cavopulmonary anastomosis was performed at 7 weeks. The median follow-up period of 26 survivors was 34 months (range 3 to 106), 4 after bidirectional superior cavopulmonary anastomoses and 1 after a Fontan procedure. In conclusion, in neonatal Ebstein's anomaly of the tricuspid valve, prolonged patency of the ductus arteriosus in patients without anatomic outflow tract obstructions is deleterious. "Circular shunts" may develop in patients with pulmonary and tricuspid insufficiency. The ligation or spontaneous constriction of the ductus arteriosus may result in hemodynamic improvement. This approach to neonatal Ebstein's anomaly of the tricuspid valve has yielded a substantial reduction in mortality to 7% in a high-risk cohort.

234 Surgical Closure of A Patient Ductus Arteriosus (PDA) is Associated with Increased Neuro-Sensory Impairment in Extremely Low Birth Weight (ELBW) Infants: Results from The Trial of Indomethacin Prophylaxis in Preterms

Background: The Victorian Infant Collaborative Study Group has reported that surgery with general anesthesia during the initial hospitalization increases the risk of adverse sensorineural outcome in ELBW infants. PDA ligation was the single most frequent type of surgery in this study. Objective: To determine whether surgical PDA closure was a risk factor for neurosensory impairment in ELBW infants who participated in the international Trial of Indomethacin Prophylaxis in Preterms (TIPP). Methods: Using the TIPP database, we studied 1180 children who survived their first day of birth. Infants were divided into 3 groups according to their PDA status in the NICU: ‘No PDA', ‘Non-surgical PDA', and ‘Surgical PDA'. As in TIPP, the primary outcome was a composite of death or neurosensory impairment at a corrected age of 18 months (cerebral palsy, cognitive delay, deafness, and blindness). Deaths and impairments were also examined separately. Odds ratios and 95% confidence intervals were calculated to estimate the differences in prognostic risk for the ‘No PDA' and the ‘Surgical PDA' groups in comparison with the ‘Non-surgical PDA' group. The analysis was adjusted for gestational age, gender, multiple birth, antenatal steroids, mother's education, and moderate to severe pulmonary hemorrhage. We also examined the relationship between the rate of surgical PDA closure in individual study centres and the 18-month outcome. Results: The results are summarized in the table. There was a significant direct correlation between the rates of surgical PDA closure in individual study centres and the prevalence of neurosensory impairments in survivors (p=0.032). Conclusion: Surgical PDA closure was associated with reduced mortality but increased neurosensory impairment in ELBW infants. It remains uncertain whether PDA ligation is a cause or a marker of adverse long-term outcome in this population.

Patent Ductus Arteriosus in the older Dog

Objectives The objectives of this study were to describe the clinical course of Patent Ductus Arteriosus (PDA) in older canine patients (defined as patients greater than 24 months at the time of presentation) with and without intervention. This study was also undertaken to evaluate if adult dogs with persistent flow across the ductus should still be closed, what the benefits are from late closure, and to hypothesise why some animals still continue to deteriorate despite closure. Background Currently accepted therapies for patent ductus arteriosus are surgical ligation and transcatheter coil embolisation. The majority of dogs are diagnosed and treated at young age. Some older dogs survive with few clinical signs and live a normal life span without intervention. Some dogs deteriorate despite intervention. Methods The case records of 24 dogs that had reached 24 months of age before diagnosis were reviewed and those animals that had no concurrent congenitaal cardiac diseases were included in the study (n = 21). Those animals that were still alive were requested to participate in a long-term follow-up study. Results After closure of the ductus (n = 16), the clinical signs disappeared in all but one animal. On follow-up of these animals, there was echocardiographic evidence of left ventricular systolic and diastolic dysfunction in many. Late cardiac death was recorded in 3 animals. In dogs where there was no intervention congestive heart failure was a common, but not an inevitable sequel. Development of mitral valve endocardiosis was a common feature. Conclusions Older animals with PDA follow an individual course, independent of pre-existing heart failure. Irreversible left ventricular dysfunction is common, however it does not seem to affect the clinical course. These data show a favourable outcome in a high percentage of adult dogs diagnosed with PDA that undergo closure. Outcome without intervention was less favorable.

Advantages and disadvantages of coils for transcatheter closure of patent ductus arteriosus.

Different coils have been used to close the patient ductus arteriosus (PDA). In small- and moderate-sized PDA, coils are an adequate alternative to surgery and/or to other devices. The aim of the study is to review and discuss the advantages and disadvantages of using coils (excluding PFM coils PFM Medical, Germany) to close PDA. Cambier was the first to successfully close a PDA using a Gianturco coil. To date, thousands of patients worldwide have undergone transcatheter closure of PDA using this or other types of coils. The use of coils is analyzed with regard to costs in comparison with other therapeutic modalities; techniques--anterograde, retrograde approach, selection of coil size--in relation to the size of the PDA and the available sizes of coils; efficacy of the rate of complete occlusion and the need for reocclusion; and safety in relation to embolization rate, other complications including hemolysis, left pulmonary artery LPA stenosis and coarctation. It is concluded that coils are a cheap alternative for the occlusion of PDA in the small-to-moderate PDA. The technique can be learned quite quickly, it has a high rate of complete occlusion, and has an acceptable rate of safety. The disadvantages include a moderate rate of coil embolization and of hemolysis in patients with residual shunt after coil occlusion in large PDAs. When more than one coil is used, the potential for developing LPA stenosis is high.

Results of U.S. phase I and II clinical trials of transcatheter closure of patent ductus arteriosus in adult patients using the amplatzerfi duct occlud

Results of U.S. phase I and II clinical trials of transcatheter closure of patent ductus arteriosus in adult patients using the amplatzerfi duct occlud

Doppler blood flow in obstetrics.

Our review on Doppler ultrasound in obstetrics aims to identify which vessels have a definite clinical role in obstetrics. The use of Doppler ultrasonography in the diagnosis and management of the intrauterine growth-restricted fetus improves the perinatal morbidity and mortality. However, the timing of delivery of the intrauterine growth-restricted fetus, based on Doppler ultrasonography, remains the subject of investigation. Robust data exist on the management of fetuses at risk for anemia because of red cell alloimmunization by using the middle cerebral artery peak systolic velocity. Appropriate training for the correct assessment of this vessel is fundamental. Doppler ultrasonography of the umbilical artery is useful in the counseling of patients with pregnancies complicated by twin-twin transfusion syndrome. Recently, Doppler ultrasonography has been shown to be helpful to the obstetricians in the diagnosis of the IUGR fetus, diagnosis of fetal anemia, twin-twin transfusion syndrome. These are the basis for timing the delivery of the IUGR fetus. However, more data are necessary. Doppler ultrasonography should be used to assess the fetal ductus arteriosus in patients treated with prostaglandin inhibitors. Doppler is also an important part of the fetal echocardiogram.

Patent ductus arteriosus in elderly patients: Clinical and echocardiographic features—a case-based review

Congenital heart disease in adults is a rapidly growing field, with many operated and unoperated infants and children surviving into adulthood. Patent ductus arteriosus is an example of a congenital cardiac defect, which may enable patients to survive well into adulthood without prior recognition or correction before symptoms arise. This case illustrates the clinical and echocardiographic manifestations of patent ductus arteriosus with special emphasis on its 2-dimensional and Doppler findings. Management options for this condition are also briefly addressed. (J Am Soc Echocardiogr 2001;14:321-4.)

Invited commentary

Closure of the Patent Ductus arteriosus (PDA) in adult patients frequently presents a significant surgical challenge. The friability of the ductal tissue secondary to the presence of calcification and other atherosclerotic changes in the ductal wall and the frequent association with pulmonary artery hypertension make the conventional division and suture procedure extremely hazardous, if not impossible. In addition the presence of endarteritis and/or aneurysmal dilatation can increase the risk of the operation markedly. Toda and associates report their clinical experience with complex PDA closure in adults using a transpulmonary approach using cardiopulmonary bypass. Temporary occlusion of the ductus is accomplished with a balloon catheter placed through the ductus. Direct closure of patch closure of the pulmonary orifice of the PDA was selected based on the quality of the tissues and the size of the communication. They used this technique in nine patients without deaths or any reported complications. Neither recanalization nor aneurysmal dilatation was recognized during the follow up period which averaged 55 months. This article confirms the findings of others [1Bhati B.S. Nandakumaran C.P. Shatapathy P. John S. Cherian G. Closure of patent ductus arteriosus during open heart surgery.J Thorac Cardiovasc Surg. 1972; 63: 820-826PubMed Google Scholar, 2Taira A. Akita H. Patch closure of the ductus arteriosus an improved method.Ann Thorac Surg. 1976; 21: 454-455Abstract Full Text PDF PubMed Scopus (11) Google Scholar, 3Wernly J.A. Ameriso J.L. Intra-aortic closure of the calcified patent ductus. A new operative technique.J Thorac Cardiovasc Surg. 1980; 80: 206-210PubMed Google Scholar, 4Omari B.O. Shapiro S. Ginzton L. Milliken J.C. Baumgartner F.J. Closure of short, wide patent ductus arteriosus with cardiopulmonary bypass and balloon occlusion.Ann Thorac Surg. 1998; 66: 277-278Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar, 5Toda R. Moriyama Y. Taira A. Balloon use for patent ductus arteriosus closure with cardiopulmonary bypass.Ann Thorac Surg. 1999; 67: 1215PubMed Google Scholar], that temporary balloon occlusion of the ductus and patch closure of the ductal orifice are useful techniques which circumvent most of the hazards associated with PDA closure in the adult. However, their excellent surgical results notwithstanding, this work raises two important points for commentary, namely, the use of cardiopulmonary bypass and the long term potential consequences of leaving the ductus connected to the aorta. The procedure described here requires cardiopulmonary bypass and full heparinization with the potential risk and increased cost associated with the use of the heart lung machine. In addition, this technique implies surgical manipulation and suturing of the pulmonary artery which is frequently thin and friable due to pulmonary artery hypertension. More importantly, with the transpulmonary closure the PDA remains exposed to systemic pressure with the potential for thrombosis, infection or aneurysmal dilatation. While the authors reported the absence of any ductal complication in their patients, it is unknown what will be the long term consequences of the surgically created “ductal diverticulum”. Concerns about the potential complications of leaving the ductus connected to the aorta have led the commentator and others to recommend transaortic closure of the PDA. Safe temporary aortic occlusion can reproducibly be achieved with the use of temporary heparin coated aortic shunts without the need for heparinization or cardiopulmonary bypass. Recently, we have exclusively favored the use of active shunts. In these conditions, patch closure of the aortic orifice can safely be performed with continuous suture (most commonly) which can be brought outside for tying. Patient selection is assisted by non-invasive aortic imaging studies which permits the assessment of aortic pathology that could contraindicate this technique. In my opinion transpulmonary closure of the PDA should be reserved to patients undergoing concomitant cardiac procedures or for patients in whom the severity of aortic atherosclerosis make unwise to proceed with transaortic closure.

Echocardiographic evaluation of the ductal morphology in patients with refractoriness to lipo-prostaglandin E1 therapy

Lipo-prostaglandin (PG)E1 is effective at lower doses and has fewer side effects than PGE1-cyclodextrin (CD). Previous studies, however, have suggested that some patients show refractoriness to lipo-PGE1 in the course of treatment. The present paper examines: (i) whether such cases can be predicted by examining the ductal morphology before and 24 h after the start of lipo-PGE1 infusion; and (ii) whether PGE1-CD dilates the ductus arteriosus in patients with refractoriness to lipo-PGE1. The ductal morphology was evaluated with two echo indices, such as minimal and minimal plus maximal intraluminal diameters of the ductus. Two-dimensional echocardiography was performed in 24 patients with ductus-dependent congenital heart disease. The two echo indices were measured before and 24 h after lipo-PGE1 infusion and also at least twice per week until surgery. In 19 of 24 patients, ductal patency was maintained until surgical treatment (group A). The remaining five patients (21%) showed ductal closure during the course of the lipo-PGE1 therapy (group B). There were no significant differences between the two groups, in either the maximal or minimal diameters, which were examined before and 24 h after treatment. In the five patients of group B, lipo-PGE1 was replaced with a relatively high dosage of PGE1-CD (50-100 ng/kg per min), resulting in good ductal patency until surgery. Patients with refractoriness to lipo-PGE1 therapy could not be predicted from initial intraluminal diameters of the ductus using echocardiography. Therefore, serial echocardiographic examinations are important to detect early findings of ductal closure. In addition, PGE1-CD is still useful as back-up therapy in such patients.

Prognostic value of color Doppler echocardiographic findings in premature newborns with patent ductus arteriosus.

This study intended to evaluate the relationship between the prognosis for premature newborns (PM) with patient ductus arteriosus (PDA) and their Doppler echocardiographic findings. From January 1989 to December 1995, of 369 premature newborns in their first postnatal week, 196 underwent ductal evaluations echocardiographically: 47 of these 196 cases were found to have PDA. Each echocardiogram had complete data for cardiac output, ejection fraction, the left atrial-to-the-aortic ratio (LA/AO), the systolic time interval of the right ventricle (RVSTI), the transvalvular pressure gradient from tricuspid regurgitation (TGTR) and ductal Doppler color flow maps. These 47 premature newborns with PDA were grouped into (A) "asymptomatic" patients whose ductus closed spontaneously within a one-year follow-up (15 subjects), (B) "symptomatic" patients whose ductus were closed by pharmacological or surgical managements (20 subjects), and (C) "complicated" patients whose ductus caused mortality of the host (12 subjects). The remaining 149 premature newborns with a closed ductus (CD) served as controls. The RVSTI in these 47 premature newborns with PDA was found to be significantly higher than those of 149 CD (0.26 +/- 0.12 vs. 0.18 +/- 0.06, p < 0.005), and denoting that PM-PDA had a higher mean pulmonary arterial pressure. The TGTR of these 47 premature newborns with PDA was also higher than these of the 149 CD controls (30.50 +/- 11.85 mmHg vs. 20.54 +/- 6.88 mmHg, p < 0.005), denoting that PM-PDA had a higher pulmonary arterial systolic pressures. Gestational age of group C neonates was younger than group A (29.46 +/- 3.41 weeks vs. 32.80 +/- 2.78 weeks, P < 0.01). The birth weight of Group C neonates was lower than that of Group A (1366.17 +/- 684.28 gm vs. 2061.67 +/- 751.77 gm. p < 0.01), therefore, extreme prematurity and small-for-gestational-age could have increased the mortality of PM-PDA. Doppler color flow maps of group C showed a wider ductal patency, less ductal waist-narrowing, more vehement red-color forward flow and less midstream mosaicism. It was concluded that patient with extreme prematurity, with very-low-birth-weight or wider patent ductus, higher pulmonary hypertension, less midstream mosaicism, or less ductal waist-narrowing would have a poorer prognosis.

Transcatheter closure of the patient ductus arteriosus in adults using the Gianturco coil.

Although results of surgical ligation of the patent ductus arteriosus (PDA) in the pediatric age group are excellent, surgical management of the adult with a PDA may be more problematic. The PDA that presents in adulthood may be calcified and friable, rendering simple ligation via a thoracotomy difficult, inadequate, and hazardous. Patch closure of the ductus arteriosus from either the aortic or pulmonary artery orifice using cardiopulmonary bypass or transient aortic cross-clamping is necessary but increases surgical risk. Furthermore, older patients with diseases unrelated to their PDA and patients with Down's syndrome may have higher risks with intubation, general anesthesia, and surgery. Early results of percutaneous transcatheter occlusion of the PDA with Gianturco coils performed under sedation and local anesthesia are promising. Six adults with mean age of 39.1 years (range 23.1-62.0 years) were found to have an isolated PDA with mean minimum diameter of 2.7 mm (range 1.0-5.0 mm) at cardiac catheterization. All underwent percutaneous transcatheter occlusion of the PDA using Gianturco coils. Coil implantation was successful in all patients. There were no complications and all were discharged home within 24 hours. Complete ductal occlusion was seen immediately in 4 of 6 patients (67%) while 2 of 6 (33%) had small residual leaks. However, complete occlusion was achieved in all patients by 6 months following the procedure. Transcatheter occlusion of the PDA using coils is safe and efficacious in adults.

Video-Assisted Thoracoscopic Ligation of Patent Ductus Arteriosus in Children

Video-assisted thoracoscopic surgery is a new approach that offers an alternative to open surgical ligation of the patient ductus arteriosus. Advanced video technology precise pediatric instrumentation, and innovative surgical techniques have facilitated the development of this approach. From April 1993 to February 1995, this procedure was performed at a large pediatric medical center on more than 100 pediatric patients with a wide range of ages and weights. There was a collaborative effort among all disciplines, and perioperative nurses on the cardiac OR team were challenged to become proficient with this new procedure through inservice sessions, ongoing education, and hands-on experience.

Applicability of transesophageal imaging of the flow convergence region for evaluating patient ductus arteriosus

Applicability of transesophageal imaging of the flow convergence region for evaluating patient ductus arteriosus

Intraaortic spring coil loops: Early and late results

Our aim was to determine the late fate of intraaortic spring coil loops after embolization of aortopulmonary vessels. In some aortopulmonary collateral vessels and patent ductus arteriosi, the narrowest segment is close to the aorta; coils used to close such vessels will "straddle" the lesion, allowing one or more coil loops to protrude into the aortic lumen. The consequences of this procedure are unknown. We reviewed the cineangiograms of all patients who had at least one aortopulmonary collateral vessel or patent ductus arteriosus closure between January 1, 1988 and August 31, 1993. From this group, 53 patients had multiple-plane angiographic evidence of intraaortic coil loops. All subsequent cineangiograms were reviewed to determine coil position or movement and evidence of recanalization or endothelial coverage of the coil loop. We also reviewed each hospital record or communicated directly with referring physicians to identify any subsequent complications such as emboli or endocarditis. Of the 53 patients with intraaortic coil loops, 49 patients had closure of one or more aortopulmonary collateral vessels (59 vessels), and 4 had closure of a patient ductus arteriosus (4 vessels). Patient follow-up ranged from 1 day to 66 months (median 20 months); follow-up was not available in 6 patients. Five of the 53 patients (9.3%; 95% confidence limits [CL] 3.1% to 20.7%) died at operation or of end-stage heart failure. Patients with late angiography had no residual flow in 31 of 35 aortopulmonary collateral vessels (88.6%; 95% CL 73.3% to 96.8%), and 0.5 mm separated the coil and aortic contrast column in all 12 coils with adequate angiography, suggesting endothelial coverage of the intraaortic coil loop. No episodes of stroke, embolic events, endocarditis or coil migration were reported. Although coil occlusion of aortopulmonary collateral vessels or patent ductus arteriosi may produce intraaortic coil loops, endothelialization appears routine. No late complications associated with intraaortic coil loops were observed.

Usefulness of interlocking detachable coil for embolization of the major aorto‐pulmonary collateral artery: A case report

A 5-yr-old male had undergone a right-modified Blalock-Taussig shunt operation at the age of 1 mo for stenotic patient ductus arteriosus and pulmonary atresia with ventricular septal defect. Before a corrective operation, the angiogram revealed one large major aorto-pulmonary collateral artery from the descending aorta to the right upper lung. Embolization of the major aorto-pulmonary collateral artery was successfully performed using interlocking detachable coils. This is the first reported case of embolization of the major aorto-pulmonary collateral artery using this device.

Detection of Cardiovascular Shunts by Transesophageal Echocardiography in Patients With Pulmonary Hypertension of Unexplained Cause

The purpose of this study was to validate the usefulness of transesophageal echocardiography (TEE) in the assessment of cardiovascular shunts in patients with pulmonary hypertension (PH) of unexplained cause. Twenty-four adult patients, 16 women, 8 men; 15 to 70 years of age, with PH of unexplained cause were studied. All were examined by transthoracic echocardiography (TTE) and TEE. TTE showed the ventricular septal defect in two patients, muscular type in one and perimembranous type in the other. TEE showed the atrial septal defect in eight patients (secundum type in six and primum type in the remaining) and the patient ductus arteriosus in six patients, which were not seen by TTE. The ventricular septal defect shown by TTE was also found by TEE. Patients with a ventricular septal defect were also associated with a patient ductus arteriosus. Among 14 patients with cardiovascular lesions, nine patients displayed a pattern of bidirectional shunt, four a pure left-to-right shunt, and the remaining one a pure right-to-left shunt. All of the cardiovascular defects could be confirmed by passage of the catheter across the defect at cardiac catheterization. In light of PH, transthoracic identification of cardiovascular shunts is difficult because of the low velocity across the defect. In this study, we found that TEE was superior to TTE in detecting and localizing cardiovascular malformations in patient with PH.

Transsternal repair of coarctation and associated cardiac defects

Over a 13-year period, 20 infants and children underwent transsternal approach for repair of coarctation and associated cardiac defects. Fifteen patients (75%) were operated on in the last 6 years. Thirteen patients (group 1) had intracardiac shunts and 7 (group 2), intracardiac obstruction of valvular insufficiency. Group 1 had a mean age of 0.8 ± 1.9 years versus 4 ± 3 years for group 2 ( p = 0.05). There were 12 patients (92%), 7 months old or less in group 1. Aortic arch hypoplasia was present in 6 patients in group 1. A large patent ductus arteriosus was present in 5 of these 6 patients versus no patent ductus arteriosus in patients without aortic arch hypoplasia ( p = 0.006). The mean pulmonary blood flow to systemic blood flow ratio in group 1 was 3.8 ± 2 and the mean right ventricular to left ventricular ratio, 0.8 ± 0.2. The coarctation repair fell mostly into three types: side patch aortoplasty (8), ductal tissue excision and patch aortoplasty of the concavity of the aortic arch (6), and subclavian aortoplasty (4). There was one early death (5%) which was due to sepsis in a newborn. Another newborn who had subclavian aortoplasty needed a left carotid artery—descending aorta bypass conduit early because of aortic arch hypoplasia. All patients were followed to 12 years (mean follow-up, 4.3 ± 3.5 years). There were no late deaths. Two patients had recurrent coarctation, 1 after an end-to-end repair and the other because of incomplete arch enlargement after a side patch aortoplasty. We conclude that a transsternal approach, which minimizes incisions and reoperations, can be safely accomplished in infants and children to repair coarctation and associated cardiac defects. Although most coarctation repair techniques could be performed, ductal tissue excision with patch aortoplasty of the concavity of the arch appears simple and provides an excellent option for complete relief of obstruction, unhampered aortic growth, and probably reduced aneurysm formation.

Tratamento do canal arterial persistente em neonatos prematuros: análise de 18 casos

A presente investigação tem o propósito de analisar, retrospectivamente, os resultados obtidos em 18 pacientes neonatos prematuros, submetidos a operação para oclusão da PCA, no período entre julho de 1990 e dezembro de 1993 (42 meses), sendo 12 (66,6%) pacientes do sexo feminino, com idade que variou entre 10 e 44 (20,8±8,3) dias, idade gestacional entre 26 e 28 (27,2±0,9) semanas. No dia da operação o peso dos pacientes esteve compreendido entre 700 e 1380 (985,8±181,6) gramas. A insuficiência respiratória aguda ocorreu em todos os pacientes sendo a principal indicação cirúrgica, estando em 6 (33,3%) pacientes associada à insuficiência cardíaca congestiva. A indometacina endovenosa foi utilizada no período pré-operatório em 9 (50%) pacientes na tentativa de se obter o fechamento farmacológico, sem sucesso, do canal arterial e apesar de não influenciar nos resultados pós-operatórios, apresentou como principal efeito secundário a redução significativa da diurese (p<0,001), que se normalizou após quatro dias do uso da droga. A técnica operatória empregada foi a toracotomia póstero-lateral esquerda trans-pleural com fixação de três ou quatro clipes metálicos para oclusão do canal arterial. O exame ecocardiográfico pré-operatório, realizado em 15 (83,2%) pacientes, mostrou que a relação entre o diâmetro do átrio esquerdo/aorta estava aumentada em todos os pacientes, sendo observado em 4 (22,2%) com até 30 dias da operação e apenas 1 (55%) paciente com quatro meses após a operação, evidenciando tendência de normalização da função cardíaca. Um (5,5%) paciente apresentou reabertura do canal arterial no pós-operatório imediato, sendo submetido à reoperação para ligadura do canal. Não foi observada diferença significativa no tempo necessário de intubação orotraqueal (IOT) (p=0,586) bem como do tempo de permanência com fração inspiratória de oxigênio (FIO2) < 40% e > 40% < 60% no período pré e pós-operatório (p=0,841 e p=0,692, respectivamente), mas com redução significativa do tempo de permanência com FIO2 > 60% (p=0,033). O período de internação hospitalar variou de 43 a 157 (96,0±24,8) dias. Não houve mortalidade operatória, observando-se ainda baixa morbidade com este método. As causas de óbito, no período pós-operatório, não estiveram relacionadas com o tratamento cirúrgico. Pode-se concluir que a ligadura cirúrgica da PCA, nos pacientes neonatos e prematuros, é método eficaz e seguro podendo ser praticado com baixa morbidade e mortalidade.