Extremely Low Birth Weight Infants with Patent Ductus Arteriosus: Searching for the Least Invasiveness
AbstractPatent ductus arteriosus (PDA) is an important problem in premature infants. Extremely low birth weight infants (ELBWI) are so fragile with respect to surgical stress that minimally invasive procedures are required. We report 26 ELBWI cases with PDA who underwent surgical closure. All had failed indomethacin treatment, or it had been contraindicated. The mean gestational age at birth was 27 weeks (range, 24-38 weeks), and the mean birth weight was 960.96 g (range, 710-1440 g). The mean age at operation was 18.06 days (range, 7-34 days), and the mean body weight at operation was 989.42 g (range, 680-1460 g). There was no surgery-related mortality or morbidity. Our surgical procedures consisted of posterior muscle-sparing thoracotomy, clipping the PDA and no ligation, and closing the thorax without a tube thoracostomy. Muscle-sparing thoracotomy reduces the likelihood of long-term physical impairment and deformity, the clipping technique minimizes the dissection of surrounding PDA tissue, and the thorax is closed without a tube. Nursing care is simplified, costs are reduced, and the number of chest x-rays needed postoperatively is reduced. We believe that surgical closure of PDA without chest tube drainage can be accomplished safely in premature infants.
Bancalari E. 2001. Changes in the pathogenesis and prevention of chronic lung disease of prematurity. Am J Perinatol 18:1-9.nCassady G, Crouse DT, Kirklin JW, et al. 1989. A randomized, controlled trial of very early prophylactic ligation of the ductus arteriosus in babies who weighed 1000 g or less at birth. N Engl J Med 320:1511-6.nChang CI. 2005. Surgical treatment of patent ductus arteriosus in premature infents with extremely low birth weight. Acta Cardiol Sin 21:35-6.nCoombs RC, Morgan MEI, Durbin GM, Booth IW, McNeish AS. 1990. Gut blood flow velocities in the newborn: effects of patent ductus arteriosus and parenteral indomethacin. Arch Dis Child 65:1067-71.nCotton RB, Stahlman MT, Bender HW, et al. 1978. Randomized trial of early closure of symptomatic patent ductus arteriosus in small preterm infants. J Pediatr 93:647-51.nFan LL, Campbell DN, Clarke DR, et al. 1989. Paralyzed left vocal cord associated with ligadon of patent ductus arteriosus. J Thorac Cardiovasc Surg 98:611-3.nForster R. 1993. Thoracoscoplc clipping of patent ductus arteriosus in premature infants. Ann Thorac Surg 56:1418-20.nGarland J, Buck R, Weinberg M. 1994. Pulmonary hemorrhage risk in infants with a clinically diagnosed patent ductus arteriosus: a retrospective cohort study. Pediatrics 94:719-23.nGersony WM, Peckham GJ, Ellison RC, et al. 1983. Effects of indomethacin in premature infants with patent ductus arteriosus: results of a national collaborative study. J Pediatr 102:895-906.nGreene F. 2002. Outcomes of very low birth weight in young adults. N Engl J Med 346:146-8.nGrosfeld JL, Chaet M, Molinari F, et al. 1996. Increased risk of necrotizing enterocolitis in premature infents with patent ductus arteriosus treated with indomethacin. Ann Surg 224:350-57.nHaneda N, Masue M, Tanaka M, et al. 2001. Transcatheter closure of patent ductus arteriosus in an infant weighing 1180 g. Pediatr Int 43:176-8.nJim WT, Chiu NC, Chen MR, et al. 2005. Cerebral hemodynamic change and intraventricular hemorrhage in very low birth weight infants with patent ductus arteriosus. Ultrasound Med Biol 31:197-202.nKida Y. 2002. Extremely low birth weight infents and cerebral palsy. Pediatr Jpn 43:795-802.nKnight DB. 2001. The treatment of patent ductus arteriosus in preterm infents. A review and overview of randomized trials. Semin Neonatol 6:63-73.nLittle DC, Pratt TC, Blalock SE, Krauss DR, Cooney DR, Custer MD. 2003. Patent ductus arteriosus in micropreemies and full-term infents: the relative merits of surgical ligation versus indomethacin treatment. J Pediatr Surg 38:492-6.nMavroudis C, Backer CL, Gevitz M. 1994. Forty-six years of patent ductus arteriosus division at Children's Memorial Hospital of Chicago. Standards for comparison. Ann Surg 220:402-9.nMiles RH, DeLeon SY, Muraskas J, et al. 1995. Safety of patent ductus arteriosus, closure in premature infants without tube thoracostomy. Ann Thorac Surg 59:668-70.nPanagopoulos PG, Tatooles CJ, Aberdeen E, Waterston DJ, Carter RE. 1971. Patent ductus arteriosus in infants and children. A review of 936 operations. Thorax 26:137-44.nRashkind WJ, Cuaso CC. 1979. Transcatheter closure of patent ductus arteriosus. Successful use in a 3.5 kilogram infent. Pediatr Cardiol 1:3-7.nSorensen KE, Kristensen B, Hanson OK. 1991. Frequency of occurrence of residual ductal flow after surgical ligation by color-flow mapping. Am J Cardiol 67:653-4.nThis T, Winthrop AL, Pipe S, et al. 1993. Optimal management of patent ductus arteriosus in the neonate weighing less than 800 g. J Pediatr Surg 28:1137-9.nVan Overmeire B, Smets K, Lecoutere D, et al. 2000. A comparison of ibuprofen and indomethacin for closure of patent ductus arteriosus. N Engl J Med 343:674-81.nVida VL, Lago P, Salvatori S, et al. 2009. Is there an optimal timing for surgical ligation of patent ductus arteriosus in preterm infants? Ann Thorac Surg 87:1509-16.nWheatley CM, Dickinson JL, Mackey DA, Craig JE, Sale MM. 2002. Retinopathy of prematurity: recent advances in our understanding. Br J Ophthalmol 86:696-700.n
How to Cite
Author Disclosure & Copyright Transfer Agreement
In order to publish the original work of another person(s), The Heart Surgery Forum® must receive an acknowledgment of the Author Agreement and Copyright Transfer Statement transferring to Forum Multimedia Publishing, L.L.C., a subsidiary of Carden Jennings Publishing Co., Ltd. the exclusive rights to print and distribute the author(s) work in all media forms. Failure to check Copyright Transfer agreement box below will delay publication of the manuscript.
A current form follows:
The author(s) hereby transfer(s), assign(s), or otherwise convey(s) all copyright ownership of the manuscript submitted to Forum Multimedia Publishing, LLC (Publisher). The copyright transfer covers the exclusive rights to reproduce and distribute the article and the material contained therein throughout the world in all languages and in all media of expression now known or later developed, including but not limited to reprints, photographic reproduction, microfilm, electronic data processing (including programming, storage, and transmission to other electronic data record(s), or any other reproductions of similar nature), and translations.
However, Publisher grants back to the author(s) the following:
- The right to make and distribute copies of all or part of this work for use of the author(s) in teaching;
- The right to use, after publication in The Heart Surgery Forum, all or part of the material from this work in a book by the author(s), or in a collection of work by the author(s);
- The royalty-free right to make copies of this work for internal distribution within the institution/company that employs the author(s) subject to the provisions below for a work-made-for-hire;
- The right to use figures and tables from this work, and up to 250 words of text, for any purpose;
- The right to make oral presentations of material from this work.
Publisher reserves the right to grant or refuse permission to third parties to republish all or part of the article or translations thereof. To republish, such third parties must obtain written permission from the Publisher. (This is in accordance with the Copyright Statute, United States Code, Title 17. Exception: If all authors were bona fide officers or employees of the U.S. Government at the time the paper was prepared, the work is a “work of the US Government” (prepared by an officer or employee of the US Government as part of official duties), and therefore is not subject to US copyright; such exception should be indicated on signature lines. If this work was prepared under US Government contract or grant, the US Government may reproduce, royalty-free, all or portions of this work and may authorize others to do so, for official US Government purposes only, if the US Government contract or grant so requires.
I have participated in the conception and design of this work and in the writing of the manuscript and take public responsibility for it. Neither this manuscript nor one with substantially similar content under my authorship has been published, has been submitted for publication elsewhere, or will be submitted for publication elsewhere while under consideration by The Heart Surgery Forum, except as described in an attachment. I have reviewed this manuscript (original version) and approve its submission. If I am listed above as corresponding author, I will provide all authors with information regarding this manuscript and will obtain their approval before submitting any revision. I attest to the validity, accuracy, and legitimacy of the content of the manuscript and understand that Publisher assumes no responsibility for the validity, accuracy, and legitimacy of its content. I warrant that this manuscript is original with me and that I have full power to make this Agreement. I warrant that it contains no matter that is libelous or otherwise unlawful or that invades individual privacy or infringes any copyright or other proprietary right. I agree to indemnify and hold Publisher harmless of and from any claim made against Publisher that relates to or arises out of the publication of the manuscript and agree that this indemnification shall include payment of all costs and expenses relating to the defense of any such claim, including all reasonable attorney’s fees.
I warrant that I have no financial interest in the drugs, devices, or procedures described in the manuscript (except as disclosed in the attached statement).
I state that the institutional Human Subjects Committee and/or the Ethics Committee approved the clinical protocol reported in this manuscript for the use of experimental techniques, drugs, or devices in human subjects and appropriate informed consent documents were utilized.
Furthermore, I state that any and all animals used for experimental purposes received humane care in USDA registered facilities in compliance with the “Principles of Laboratory Animal Care” formulated by the National Society for Medical Research and the “Guide for the Care and Use of Laboratory Animals” prepared by the Institute of Laboratory Animal Resources and published by the National Institutes of Health (NIH Publication No. 85-23, revised 1985).