Occlusion of large window/tubular-type patent ductus arteriosus after constriction via a small chest incision
Objective To investigate the therapeutic efficacy and evaluate the safety of a procedure involving partial ring constriction of patent ductus arteriosus (PDA) followed by complete occlusion with an occluder guided by transesophageal echocardiography (TEE),in 14 children with large window/tubular-type PDA. Methods A retrospective study was conducted on 14 children with large window/tubular-type PDA,who were admitted from September 2017 to September 2022. The surgical method involved partial ring constriction of the PDA via a small transthoracic incision,followed by puncture at a suitable position on the anterior wall of the main pulmonary artery and placement of a suitable ventricular septal occluder to completely seal the remaining PDA lumen. The operation time,blood loss,postoperative hospital stay,and incidence of postoperative complications were recorded,and the patients were followed-up regularly in outpatient clinics after discharge. Results All 14 children successfully underwent PDA treatment,and none of them required conversion to mesh repair or PDA ligation under cardiopulmonary bypass. The average operation time was (54.3±13.7) min,and patients were transferred back to the general ward after extubation through a fast-track protocol. No blood transfusions were needed. The average hospital stay after surgery was (4.7±1.5) days. There were no complications such as occluder displacement,residual shunt,hemolysis,or pericardial effusion. The average follow-up period was (46.6±10.8) months,and there were no residual shunts,occluder displacement,or pericardial effusion. Conclusion TEE-guided transthoracic small incision surgery can achieve satisfactory outcomes through partial ring constriction of large window/tubular-type PDA followed by occlusion of the remaining lumen. This approach can avoid the trauma of cardiopulmonary bypass and reduce the risk of PDA rupture and massive bleeding associated with direct ligation.
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