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Surgical treatment indications in the newborn patent arterial duct

E. Haraux, G. Kongolo, A. Leke, S. Goudjil, P .Buisson, M. Hamzy, J. Ricard, G. Krim, JP. Canarelli

Pediatric Unit, CHU Amiens, France

 

ABSTRACT

Introduction: The frequency of the patent arterial duct (PAD) increases with prematurity, determining pulmonary lesions, pulmonary hypertension, then heart failure sometimes aggravated in the case of enterocolitis determined by a low mesenteric vascular flow. An early diagnosis by echocardiography, before any sign of decompensation, allows the beginning of the medical treatment: atraumatic assisted ventilation, surfactant and Ibuprofen. An early surgical treatment must be indicated in case of contraindication or of failure of the medical treatment (renal insufficiency, thrombopenia…).

Material and methods: Our experience of 425 cases of PAD treated from 1999 to 2008, from which 65 were operated (15%). The gestational age varied from 24 to 37 SA, with a birth weight of 642 to 3260g (average:1485g). The surgical treatment consisted of placing a clip by left thoracotomy in the 3rd space.

Results: In this series the total death rate was 20%. Average postoperative ventilation duration was 17 days; no postoperative complications related to the intervention.

Discussion: The early diagnosis by echocardiography permits to have an effective medical treatment in 65% of the cases. The existence of a low mesenteric flow to the Doppler ultrasonography is an argument for the surgical treatment of the high flow patent arterial duct. The effectiveness of the early medical treatment must be controlled by delayed ultrasounds to detect eventual recanalization of the PAD (5 cases at 3 to 8 months after surgery).

Conclusion: the surgical indication of PAD must be proposed in case of failure or of contraindication to the medical treatment, or in case of low mesenteric flow to the Doppler ultrasonography. Any early medical treatment must be controlled at distance to detect secondary recanalization.

 

Key words: patent arterial duct, prematurity, low mesenteric flow