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Surgical Experience with Closure of an Isolated PDA at Muhimbili Cardiothoracic Unit in Dar es Salaam, Tanzania
Nyawawa, E.T.M.; Ussiri, E.; Njelekela, M. A.; Mpoki, U.; Nyangassa, B. J.; Wandwi, W.B.C. & Lugazia, E.
Abstract
Background:
This study describes our experience in the management of isolated patent ductus
arteriosus; complications and mortality rate. Further it describes the innovative technique for the
closure of the duct.
Methods:
We retrospectively recruited all patients’ files that underwent PDA closure from May
2008 to July 2011 in all these patients clinical evaluation and confirmation of diagnosis was made
by echocardiography. There were two-treatment group. The first group underwent a standard
surgical closure and these were 26 patients this group was obtained from the usual and routinely
done PDA ligation. The second group also comprised 26 patients who had undergone a modified
closure technique as illustrated by Kirklin1. Patients’ age, sex duration of illness, stage of the
disease as classified by New York Heart Association, ventricular function as depicted by left
ventricular ejection fraction, any associated lesion were noted. During operation, confirmation of
the PDA was done and the total operation time (TOT), total duration of ventilation (VT), and any
complication were noted. The total duration of intensive care stay and the postoperative period stay
in the ward were noted. Patients had been followed at six months interval for two years; in which
during follow up evaluation for their cardiac status to exclude congestive heart failure, presence of
residual PDA had been done. All data were entered in a structured data sheet and analyses using
Spss window 17 statistical program.
Results:
A total of 52 patients with clinical diagnosis of PDA, 26 patients in each treatment group
of either standard closure or new closure technique. Female patients had outnumbered male
patients by 5.5 folds. A total of 46.1% of patients were under five years old. A relatively younger
population of patients was seen with the new closure technique as compared to patients in the
standard closure technique (p=0.02). Similarly a correspondingly less heavier weight was noted in
patients who underwent new closure technique as compared to those who had standard closure
technique(p=0.03). Long- term follow up of patients with their treatment modalities it was found
that 3 patients and 2 patients had residue lesion and congestive cardiac failure respectively who
were exclusively in the standard closure technique, none of such complications were seen with the
new closure technique (p=0.04). With such evidence, the practice to date has been the new closure
technique for definitive surgical treatment for PDA.
Conclusion
Open surgery for PDA closure remains the procedure of choice for facility and
technically deprived countries. The approach and the technique of closure that minimize the
postoperative complications is a challenge from centre to centre. However this study with a new
closure in which a purse string on the ampulla of the PDA followed by a silk ligature has proved to
be efficient and reliable technique that leaves no residual lesion with no long term complications.
Keywords
Closure; Isolated; Patent; ductus arteriosus; PDA
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