Laborde F, Folliguet T, Batisse A, Dibie A, da-Cruz E, Carbognani D
Department of Cardio-pediatric Surgery, Centre Médico-Chirurgical de la Porte de Choisy, Paris, France.
J Thorac Cardiovasc Surg. 1995 Dec;110(6):1681-4; discussion 1684-5. doi: 10.1016/S0022-5223(95)70031-5.
Video-assisted thoracoscopic surgical interruption for patient ductus arteriosus is a well-standardized procedure already described. We present our entire series of such cases, from the first case (performed on Sept. 5, 1991) to March 1, 1995. Two hundred thirty patients in a variety of age groups underwent video-assisted interruption: younger than 6 months (70 patients, 30%), 6 to 48 months (123 patients, 54%), and older than 48 months (37 patients, 16%). The mean weight was 12.6 kg (range 1.2 to 65 kg). Thirty-nine patients had symptomatic pulmonary hypertension. Associated intracardiac anomalies included atrial septal defect (three), ventricular septal defect (five), and anomalous pulmonary venous return (one). All patients underwent video-assisted interruption of the patient ductus arteriosus with two titanium clips. Closure was evaluated by postoperative echocardiography before extubation. Five patients had a persistent patent ductus after video-assisted interruption, all early in our experience and related to insufficient dissection resulting in inadequate clip placement. Four patients had successful immediate clip repositioning (three by video-assisted interruption and one by thoracotomy). Subsequent echocardiography revealed persistent closure in these patients. A persistent patent ductus arteriosus with minimal flow was discovered in one patient without symptoms after discharge. Recurrent laryngeal nerve dysfunction was noted in six patients (2.6%, five transient and one persistent). There were no deaths, hemorrhages, transfusions required, or chylothoraces in this series. Mean operative time was 20 +/- 15 minutes, and hospital stay averaged 48 hours for patients younger than 6 months and 72 hours for patients older than 6 months. This is a safe, rapid, cost-effective technique that results in excellent results and a shortened hospital stay. Video-assisted interruption represents the technique of choice for closure of a patient ductus arteriosus.
电视辅助胸腔镜手术结扎动脉导管未闭是一种已被描述的标准化手术。我们展示了自第一例手术（1991年9月5日施行）至1995年3月1日期间的所有此类病例。230例不同年龄组的患者接受了电视辅助结扎术：6个月以下（70例，30%），6至48个月（123例，54%），48个月以上（37例，16%）。平均体重为12.6千克（范围1.2至65千克）。39例患者有症状性肺动脉高压。合并的心内畸形包括房间隔缺损（3例）、室间隔缺损（5例）和肺静脉异位引流（1例）。所有患者均通过两个钛夹进行电视辅助动脉导管未闭结扎术。在拔管前行术后超声心动图评估闭合情况。5例患者在电视辅助结扎术后动脉导管持续开放，均为我们早期的经验，与分离不充分导致钛夹放置不当有关。4例患者成功立即重新放置钛夹（3例通过电视辅助手术，1例通过开胸手术）。随后的超声心动图显示这些患者动脉导管持续闭合。1例患者出院后无症状，但发现有微量血流的动脉导管未闭持续存在。6例患者（2.6%）出现喉返神经功能障碍（5例短暂性，1例持续性）。本系列无死亡、出血、输血需求或乳糜胸发生。平均手术时间为20±15分钟，6个月以下患者平均住院时间为48小时，6个月以上患者为72小时。这是一种安全、快速、经济有效的技术，效果良好且住院时间缩短。电视辅助结扎术是动脉导管未闭闭合术的首选技术。
