Surgical Experience with Closure of an Isolated PDA at Muhimbili Cardiothoracic Unit in Dar es Salaam, Tanzania

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.

Key words: Closure, Isolated, Patent, ductus arteriosus, PDA