The use of multiplane transesophageal echocardiography to evaluate residual patent ductus arteriosus during video-assisted thoracoscopy in adults

Background: Video-assisted thoracoscopic surgery (VATS) has emerged as an i nnovative and popular procedure for interruption of patent ductus arteriosu s (PDA), while intraoperative transesophageal echocardiography (TEE) has pr oven to be an effective monitor in the evaluation of residual patency. Prev ious reports on the adequacy of surgical interruption of PDA under VATS and TEE are available for pediatric patients, but only limited information is available for adults with PDA. Materials and methods: Between August 1995 and October 1997, we monitored 3 5 adult patients undergoing PDA interruption via VATS with Hewlett-Packard color Doppler multiplane TEE throughout the procedure. The average PDA diam eter was 10.2 +/- 1.8 mm. All the PDA were completely ligated. Results: Thirty-two patients showed no ductal flow after double ligation. I n the other three patients, residual flow was detected intraoperatively aft er double ligation, but it was quickly abolished by the third ligation. One patient showed faint ductal flow by transthoracic echocardiography at post operative follow-up, but no reintervention was needed. Conclusions: Our study showed that, with the refinement of adult PDA interr uption via VATS, intraoperative multiplane TEE provides higher resolution f or direct evaluation of the entire course of PDA ligation without interrupt ing the surgical procedure and minimizes the incidence of complications.