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A Simplified Method of Ligation of Patent Ductus Arteriosus in Premature Infants
HOW TO DO IT
A Simplified Method of Ligation of Patent Ductus Arteriosus in Premature Infants Richard C. Traugott, M.D., Raymond J. Will, M.D., George F. Schuchmann, M.D., a n d Robert L. Treasure, M.D. ABSTRACT A clip technique for ligation of the
ductus arteriosus in premature infants is presented.
Suture ligation is a standard surgical treatment for patent ductus arteriosus (PDA) in the premature infant. To minimize the operative time in these very ill infants who tolerate retraction of the lung poorly, the procedure is done without obtaining tape control of the proximal and distal aorta. Without this additional control, unexpected ductal bleeding can be more difficult to control. From June, 1974, to January, 1979, we employed ligaclip ligation in 11 of 53 consecutive surgically treated patients with PDA. The technique was used when the patient’s hemodynamic state permitted only minimal lung retraction (4 patients) or when ductal hemorrhage was encountered (7 patients). Technique The ductus is approached through a limited posterolateral incision. With the recurrent nerve retracted anteriorly, the ductus is sharply exposed above and below to allow its complete occlusion with a vascular forceps (Figure). A medium ligaclip (Ethicon LC 200a) is applied to the ductus on either side of the occluding forceps with a medium applier. If, when the suture ligation technique is used, the ductus is torn while passing the right angle clamp under it, control can usually be achieved with forceps occlusion of the duct while the clips are applied. In all 11 patients, duct occlusion appeared to be complete.
above and below the ductus is important to preclude tearing with forceps occlusion and ligaclip application. The ligaclip technique has been used only in premature infants. The long-term results are not known, but the immediate goal of complete, rapid ductal occlusion seems to be accomplished well. The average period of hospitalization following ligation was fifty-one days, and at discharge none of the patients had evidence of a patent ductus. Two patients subsequently died of intracerebral bleeding and at postmortem examination were found to have complete ductal closure with the ligaclips. Although it seems appealing to ligate every premature ductus with the ligaclip technique, we reserve this method for two specific situations-ductal bleeding and hemodynamic deterioration with minimal lung retraction. Reference 1. Wright JS, Newman DC: Ligation of the patent ductus: technical considerations at different ages.
J Thorac Cardiovasc Surg 75:695,1978
The technique of ligaclip application in the premature infant: (A) anatomical configuration; (€3) occlusion of the ductus with vascular forceps; and (C) ligaclips in place.
Comment In no patient was the ductus tom by the ligaclip application. We believe that sharp dissection From the Cardiothoracic Surgery Service, Brooke Army Medical Center, Fort Sam Houston, TX. Accepted for publication Mar 5, 1979. Address reprint requests to Dr. Traugott, Cardiothoracic Surgery Service, Brooke Army Medical Center, Fort Sam Houston, TX 78234.
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0003-4975/80/030263-01$01.25 @ 1978 by Richard C. Traugott
A
A Simplified Method of Ligation of Patent Ductus Arteriosus in Premature Infants Richard C. Traugott, M.D., Raymond J. Will, M.D., George F. Schuchmann, M.D., a n d Robert L. Treasure, M.D. ABSTRACT A clip technique for ligation of the
ductus arteriosus in premature infants is presented.
Suture ligation is a standard surgical treatment for patent ductus arteriosus (PDA) in the premature infant. To minimize the operative time in these very ill infants who tolerate retraction of the lung poorly, the procedure is done without obtaining tape control of the proximal and distal aorta. Without this additional control, unexpected ductal bleeding can be more difficult to control. From June, 1974, to January, 1979, we employed ligaclip ligation in 11 of 53 consecutive surgically treated patients with PDA. The technique was used when the patient’s hemodynamic state permitted only minimal lung retraction (4 patients) or when ductal hemorrhage was encountered (7 patients). Technique The ductus is approached through a limited posterolateral incision. With the recurrent nerve retracted anteriorly, the ductus is sharply exposed above and below to allow its complete occlusion with a vascular forceps (Figure). A medium ligaclip (Ethicon LC 200a) is applied to the ductus on either side of the occluding forceps with a medium applier. If, when the suture ligation technique is used, the ductus is torn while passing the right angle clamp under it, control can usually be achieved with forceps occlusion of the duct while the clips are applied. In all 11 patients, duct occlusion appeared to be complete.
above and below the ductus is important to preclude tearing with forceps occlusion and ligaclip application. The ligaclip technique has been used only in premature infants. The long-term results are not known, but the immediate goal of complete, rapid ductal occlusion seems to be accomplished well. The average period of hospitalization following ligation was fifty-one days, and at discharge none of the patients had evidence of a patent ductus. Two patients subsequently died of intracerebral bleeding and at postmortem examination were found to have complete ductal closure with the ligaclips. Although it seems appealing to ligate every premature ductus with the ligaclip technique, we reserve this method for two specific situations-ductal bleeding and hemodynamic deterioration with minimal lung retraction. Reference 1. Wright JS, Newman DC: Ligation of the patent ductus: technical considerations at different ages.
J Thorac Cardiovasc Surg 75:695,1978
The technique of ligaclip application in the premature infant: (A) anatomical configuration; (€3) occlusion of the ductus with vascular forceps; and (C) ligaclips in place.
Comment In no patient was the ductus tom by the ligaclip application. We believe that sharp dissection From the Cardiothoracic Surgery Service, Brooke Army Medical Center, Fort Sam Houston, TX. Accepted for publication Mar 5, 1979. Address reprint requests to Dr. Traugott, Cardiothoracic Surgery Service, Brooke Army Medical Center, Fort Sam Houston, TX 78234.
263
0003-4975/80/030263-01$01.25 @ 1978 by Richard C. Traugott
A