VIDEO-ASSISTED THORACOSCOPIC SURGICAL INTERRUPTION - THE TECHNIQUE OF CHOICE FOR PATENT DUCTUS-ARTERIOSUS - ROUTINE EXPERIENCE IN 230 PEDIATRIC CASES

Video-assisted thoracoscopic surgical interruption for patent ductus arteriosus is a well-standardized procedure already described, We present our entire series of such cases, from the first case (performed on Sept, 5, 1991) to March 1, 1995, Two hundred thirty patients in a variety of age groups underwent video-assisted interruption: younger than 6 months (70 patients, 30%), 6 to 48 months (123 patients, 54%), and older than 48 months (37 patients, 16%), The mean weight was 12.6 kg (range 1.2 to 65 kg), Thirty-nine patients had symptomatic pulmonary hypertension, Associated intracardiac anomalies included atrial septal defect (three), ventricular septal defect (five), and anomalous pulmonary venous return (one), All patients underwent video-assisted interruption of the patent ductus arteriosus with two titanium clips, Closure was evaluated by postoperative echocardiography before extubation, Five patients had a persistent patent ductus after video-assisted interruption, all early in our experience and related to insufficient dissection resulting in inadequate clip placement, Four patients had successful immediate clip repositioning (three by video-assisted interruption and one by thoracotomy). Subsequent echocardiography revealed persistent closure in these patients, A persistent patent ductus arteriosus with minimal flow was discovered in one patient without symptoms after discharge, Recurrent laryngeal nerve dysfunction was noted in six patients (2.6%; five transient and one persistent), There were no deaths, hemorrhages, transfusions required, or chylothoraces in this series. Mean operative time was 20 +/- 15 minutes, and hospital stay averaged 48 hours for patients younger than 6 months and 72 hours for patients older than 6 months, This is a safe, rapid, cost-effective technique that results in excellent results and a shortened hospital stay, Video-assisted interruption represents the technique of choice for closure of a patent ductus arteriosus.