Abbasi M Zaheer
Department of Paediatric Surgery, The Children's Hospital, Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan.
J Ayub Med Coll Abbottabad. 2009 Jul-Sep;21(3):25-8.
Surgery for Patent Ductus Arteriosus (PDA) is usually performed in specialized cardiac centres with either open surgery or percutaneous embolisation using different materials and devices. This involves high cost of treatment especially for those poor patients who have grown up to several years of age without seeking any treatment for their disease. The objective of this study is to evaluate the safety of surgery for PDA in a non cardiac paediatric surgical setup.
A total of 89 patients of 8 months to 12 years (mean 3 years) age were operated over a period of 13 years (from 1993 to 2006). Fifty-five cases were females and 34 were males. Investigations included x-ray chest, ECG and echocardiography. All patients with PDA were included in the study except those who had other associated cardiac anomaly and those who had a calcified ductus. The ductus was dissected out and ligated with non-absorbable suture (Silk No. 1 or 2). The patients were discharged by the 5th postoperative day.
In majority of the patients the recovery was smooth and uneventful. Eight patients had minor complications which were treated conservatively. There were 3 mortalities in this series; 2 patients were over 10 years of age and had calcified ductus. They died during surgery due to primary haemorrhage and 1 died after 24 hours in the intensive care unit. All patients were reviewed at 1 week, 1 month, 3 months and 1 year after surgery. In majority, the typical machinery murmur disappeared immediately or a soft systolic murmur persisted for up to 4 weeks and then disappeared.
With proper patient selection, the procedure can safely be performed in a paediatric surgical setup with facilities for cardiac monitoring. The surgeon needs to receive some additional training in the cardiac institution for safe surgery on these children. This will significantly reduce the cost with minimal complications especially for those poor patients who cannot afford the modern procedures due to monitory constraints. Children older than 10 years are not suitable for open surgery because of calcification of the duct.
动脉导管未闭（PDA）手术通常在专业心脏中心进行，可采用开放手术或使用不同材料和装置的经皮栓塞术。这涉及高昂的治疗费用，尤其是对于那些已成长至几岁却未针对其疾病寻求任何治疗的贫困患者。本研究的目的是评估在非心脏儿科手术环境中进行PDA手术的安全性。
在13年期间（从1993年至2006年），共对89例年龄在8个月至12岁（平均3岁）的患者进行了手术。其中55例为女性，34例为男性。检查包括胸部X光、心电图和超声心动图。所有PDA患者均纳入研究，但那些有其他相关心脏异常以及导管钙化的患者除外。将导管分离出来，用不可吸收缝线（1号或2号丝线）结扎。患者在术后第5天出院。
大多数患者恢复顺利，无并发症。8例患者出现轻微并发症，经保守治疗。本系列中有3例死亡；2例患者年龄超过10岁且导管钙化。他们在手术期间因原发性出血死亡，1例在重症监护病房24小时后死亡。所有患者在术后1周、1个月、3个月和1年进行复查。大多数情况下，典型的机器样杂音立即消失，或柔和的收缩期杂音持续长达4周后消失。
通过适当的患者选择，该手术可在具备心脏监测设施的儿科手术环境中安全进行。外科医生需要在心脏机构接受一些额外培训，以便对这些儿童进行安全手术。这将显著降低成本，并发症最少，尤其对于那些因经济限制而无法承担现代手术的贫困患者。10岁以上的儿童由于导管钙化不适合进行开放手术。
