VIDEO-ASSISTED THORACOSCOPIC OPERATION FOR INTERRUPTION OF PATENT DUCTUS-ARTERIOSUS IN ADULTS

Background. Patent ductus arteriosus (PDA) is a frequent congenital he art disease encountered in premature neonates, infants, and children. Video-assisted endoscopic techniques have been used in PDA interruptio n since 1993. Almost all the experiences are in pediatric patients. Ap plications in adults with PDA have been limited. Methods. We report ou r experience of video-assisted thoracoscopic surgical ligation of PDA in adults. From August 1995 to January 1996, 60 patients with PDA were operated on with a video-assisted thoracoscopic technique. Twelve adu lts were identified with mean age of 30 years (range, 20 to 57 years). With the patient under general anesthesia and double-lumen endotrache al intubation, two 5-mm holes were made in the left lateral chest wall . Another 4-cm incision was made in the left third intercostal space f or manipulation, dissection, and ligation. Conventional surgical instr uments were used except an endoscopic grasper and an endoscopic tube t hat connected to a video camera. The surgical procedure was viewed on a video screen. Transesophageal echocardiography was used for monitori ng during PDA ligation. Results. All patients had successful ligation of the PDA. There was no surgical mortality, but there was one morbidi ty; transient recurrent nerve injury, which recovered 3 months later. Ten patients were extubated in operative room and 2 patients were extu bated 2 hours after the operation. Tube thoracostomy was performed in the first 2 cases; it was omitted thereafter. No patients needed narco tic to control chest pain. Postoperative follow-up by echocardiography showed faint ductal flow in 1 patient without any murmur. All patient s were discharged within 3 days after the operation. Conclusions. Our experience suggests that with refinement of instruments and surgical t echnique, video-assisted thoracoscopic surgical ligation can be safely applied not only in pediatric patients, but also in adults with PDA. (C) 1997 by The Society of Thoracic Surgeons