Choice of surgical approach for patent ductus arteriosus

What are the surgical options for patent ductus arteriosus? Congenital patent ductus arteriosus has many complications. While we learn about congenital patent ductus arteriosus, we should also pay attention to preventing the occurrence of complications of congenital patent ductus arteriosus. If this disease occurs, what surgical method should be chosen?

(I) Arterial duct ligation is suitable for young children whose ductus is slender, whose wall is soft and elastic, and who have not suffered from bacterial infection.

1. Incision: Left posterior lateral chest incision. Enter the chest through the 4th or 5th intercostal space.

2. Pull the left lower lobe forward and downward to expose the ductal triangle formed by the left pulmonary artery, phrenic nerve and vagus nerve. Continuous tremor can be felt in this area.

3. Cut the mediastinal pleura longitudinally between the phrenic nerve and the vagus nerve to expose the ductus between the aorta and the pulmonary artery.

4. Place blocking bands on the aorta at the upper and lower ends of the free catheter.

5. Carefully separate the front and upper and lower edges of the catheter, and then bluntly separate its back wall. Avoid injuring the left recurrent laryngeal nerve during the operation. Make sure the catheter has enough length for ligation.

6. Press the arterial catheter with your fingers or clamp it with a catheter clamp for about 10 minutes to perform a blocking test. If blood pressure drops, heart rate increases, heart rate is irregular, and pulmonary artery pressure increases, the catheter should not be closed. Otherwise, the operation can continue.

7. Under the guidance of the small right-angle clamp, two No. 10 silk threads are passed through the back wall of the catheter. After the anesthesiologist lowers the blood pressure to 8N10kPa, the aortic end of the catheter is ligated first. The ligature should be tightened gradually and slowly until the tremor at the pulmonary artery end disappears, and then slightly tightened, and then the pulmonary artery side is ligated. Another stitch can also be inserted between the two threads.

8. Suture the mediastinal pleura. Place a closed chest drain. Suction sputum and expand the lungs. Suture the chest wall incision.

(ii) Arterial duct cutting and suturing is suitable for older children, those with thick and short ducts, large shunt volumes or infected ducts.

1. Incision: Left posterior lateral chest incision. Enter the chest through the 4th or 5th intercostal space.

2. Pull the left lower lobe forward and downward to expose the duct formed by the left pulmonary artery, phrenic nerve and vagus nerve: the angle area. Continuous tremor can be felt in this area.

3. Cut the mediastinal pleura longitudinally between the phrenic nerve and the vagus nerve to expose the ductus between the aorta and the pulmonary artery.

4. Place blocking bands on the aorta at the upper and lower ends of the free catheter.

5. Carefully separate the front and upper and lower edges of the catheter, and then bluntly separate its posterior wall. Avoid injuring the left recurrent laryngeal nerve during the operation.

6. Place a Potts-Smith clamp on the aorta side and two arterial clamps on the pulmonary artery side.

7. While cutting the catheter, suture the aorta side continuously back and forth.

8. Suture the pulmonary artery side in the same way.