Patent ductus arteriosus in West Indian children - abstract

ABSTRACT

Patent ductus arteriosus (PDA) is frequently seen in children presenting at referral clinics. These children are offered surgical correction as published reports indicate such therapy is quite satisfactory. This study reports the results of operative intervention (1953 to 1984) at the University Hospital (UH) and National Chest Hospital (NCH). A study of all children (<13 years) subjected to surgical correction of PDA was undertaken to evaluate the results of this operation. There were 140 females and 72 males and their ages ranged from a few weeks to 12 years (mean 4.6 years). A clinical diagnosis of PDA was made in all patients. Forty-two children were subjected to cardiac catheterisation to confirm the clinical diagnosis and/or to exclude other cardio-vascular abnormalities. Anaesthetic management included a balanced technique and induced moderate arterial hypotension to facilitate the great vessel surgery. The operative procedures performed were as follows- PDA division + suture - 151; PDA ligitation - 48; PDA division + suture & coarctation repair - 5; PDA division + suture & sub-aortic stenosis repair (OHS) - 1; PDA aneurysm repair with LA-femoral bypass - 1; No PDA at thoracotomy - 6, --division of ligamentum arteriosum, --repair of aorto-pulmonary fistulae (OHS) -1, --subsequent repair of VSD (OHS). (OHS = open heart surgery with cardio-pulmonary bypass). There was 1 intra-operative death (<0.5 per cent mortality) due to bleeding from a torn ductus (in 1965) and 1 post-operative death (<0.5 per cent mortality) caused by digoxin toxicity which occurred on day 1 in the convalescent ward. The clinical diagnosis of PDA is accurate (96.5 per cent), and the techniques of anaesthesia and surgery are associated with low morbidity and mortality. Children with PDA should therefore be considered for surgical correction (AU)