Dorsal Mini-thoracotomy for PDA Closure in Premature Neonates / 대한흉부외과학회지

ABSTRACT

BACKGROUND: Surgical closure of a patent ductus arteriosus (PDA) can be considered when conservative medical treatment is ineffective or contraindicated. Low weight and earlier gestational age neonates who are treated with conservative medical therapy generally showed a higher failure rate. The morbidity of surgical PDA closure in such extremely low birth weight (ELBW) neonates is also high. Here we present the early results of a new technique for approaching the PDA through a dorsal minithoracotomy. MATERIAL AND METHOD: From March 2006 to November 2008, 24 premature neonates underwent surgical PDA closure. The procedures were performed in the newborn intensive care unit via a 2 cm long dorsal minithoracotomy with the baby in the prone position with the left hemithorax elevated 30 degrees. Bimanual cotton swab blunt dissection completed the extrapleural access to the PDA and then two clips were applied. Tube thoracostomy was avoided if there was no meaningful pleural laceration. RESULT: The infants mean gestational age was 26.5+/-2.1 weeks (range 23 to 30 weeks) and the average age at operation was 11+/-11 days. The mean body weight at operation was 933+/-271 grams (range 570 to 1,700 grams). Eight patients expired, but there was no procedure-related death. Postoperative echocardiography revealed two cases of residual shunt but none of these shunts were detected on the follow up echocardiogram that was performed on the post operative 5 and 59 days. CONCLUSION: We concluded that the technique described here is an effective procedure in view of the satisfactory operative exposure and the low rate of complications.