CLOSURE OF PATENT DUCTUS-ARTERIOSUS BY VI DEO-THORACOSCOPY IN 45 CHILDREN

For over 20 years, different methods of interventional catherterisatio n have partially replaced surgical closure of patent ductus arteriousu s (PDA). The authors report the results of a new operative technique, video-thoracoscopy, derived from endoscopic surgery. Under general ana esthesia and after tracheal intubation, two trocarts of 5 mm diameter are introduced into the thorax for the passage of the instruments requ ired for dissection and closure of the PDA. Two hooks are also introdu ced to retract the lung and dissect the ductal region. Two 9 mm titani um clips are positioned under videoscopic control. Forty-five children underwent this procedure between February 1992 and July 1994. The ave rage age at the time of operation was 13.8 months (range: 3 to 32 mont hs) with an average weight of 14.5 kg (range: 2 to 48 kg) including 10 (22 %) with a body weight of less than 6 kg. The surgical indications were haemodynamic in 27 % of cases (large shunts with pulmonary hypert ension) and prophylactic against endocarditis in 73 % of cases. There were no operative fatalities. The immediate complications included: ch ylothorax (1 case) and left recurrent nerve paralysis (2 cases). A res idual shunt was observed in 3 of the 45 cases (6 %). In one of these c ases, a supplementary clip was effective in suppressing the residual s hunt. In the other 2 cases, the residual shunt was respected after a s econd failure of clipping the duct in one of the cases. The final clos ure rate was 95.6%. Closure of PDA by video-thoracoscopy is a rapid an d safe technique. It can be used in premature children when endovascul ar methods are impossible and in systematic closure of large ducts in children with low body weights.