A Case of PDA Patch Closure with Reverse T-Shaped Sternal, Trans-Pulmonary Approach under Circulatory Assistance / 日本心臓血管外科学会雑誌

ABSTRACT

A 63-year-old woman, in whom a continuous heart murmur had been pointed out previously, complained of congestive heart failure. The patient had undergone surgical treatment for skin cancer on the anterior chest wall, and an autologous skin graft, which partly covered the lower sternum, had been implanted. Patent ductus arteriosus (PDA) was diagnosed by an enhanced chest computed tomography (CT), ultrasonic cardiography and catheterization study. The duct was 4mm in diameter and 5mm long. The Qp/Qs was 1.65 and the L-R shunt rate was 39%. The auto-skin graft was untouched and the heart was approached with a reverse T-shaped partial sternotomy. Normothermic circulatory support with cardiopulmonary bypass was established. The PDA was closed through a left pulmonary arteriotomy with a 0.4-mm-thick PTFE patch. Without clamping the calcified aorta, a balloon catheter was advanced into the aorta through the duct to block the arterial back flow. The follow-up has been conducted with enhanced CT every 6 months and the closed duct has been confirmed.