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Successful surgical closure of an arterial duct in 18 children in a third world country

Published online by Cambridge University Press:  20 May 2010

Paul Grossfeld ,
Mark Greenberg ,
Sandra Saw ,
Gloria Cheng ,
Anthony Stanzi ,
James Mathewson ,
Ngeth Pises ,
Luy Lyda ,
Sar Vuthy  and
William Elias
...Show all authors
Paul Grossfeld*
Affiliation:
Division of Pediatric Cardiology, University of California, San Diego School of Medicine (UCSD), San Diego, California, United States of America Children’s Heart Institute, Rady Children’s Hospital of San Diego (RCHSD), San Diego, California, United States of America
Mark Greenberg
Affiliation:
Department of Anesthesia, UCSD, San Diego, California, United States of America
Sandra Saw
Affiliation:
Department of Anesthesia, RCHSD, San Diego, California, United States of America
Gloria Cheng
Affiliation:
Department of Anesthesia, UCSD, San Diego, California, United States of America
Anthony Stanzi
Affiliation:
Department of Anesthesia, RCHSD, San Diego, California, United States of America
James Mathewson
Affiliation:
Eller Congenital Heart Center, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona, United States of America
Ngeth Pises
Affiliation:
Department of Pediatrics, Angkor Hospital for Children, Siem Reap, Cambodia (AHC), San Diego, California, United States of America
Luy Lyda
Affiliation:
Department of Pediatrics, Angkor Hospital for Children, Siem Reap, Cambodia (AHC), San Diego, California, United States of America
Sar Vuthy
Affiliation:
Department of Surgery, AHC, San Diego, California, United States of America
William Elias
Affiliation:
Division of Pediatric Cardiology, University of California, San Diego School of Medicine (UCSD), San Diego, California, United States of America Children’s Heart Institute, Rady Children’s Hospital of San Diego (RCHSD), San Diego, California, United States of America
Stephanie Moriarty
Affiliation:
Children’s Heart Institute, Rady Children’s Hospital of San Diego (RCHSD), San Diego, California, United States of America
Sharon Levy
Affiliation:
Children’s Heart Institute, Rady Children’s Hospital of San Diego (RCHSD), San Diego, California, United States of America
Deborah Walter
Affiliation:
Children’s Heart Institute, Rady Children’s Hospital of San Diego (RCHSD), San Diego, California, United States of America
Phillip Panzarella
Affiliation:
Department of Respiratory Therapy, UCSD, San Diego, United States of America
Susan Grossfeld
Affiliation:
Children’s Heart Institute, Rady Children’s Hospital of San Diego (RCHSD), San Diego, California, United States of America
Jolene Kriett
Affiliation:
Children’s Heart Institute, Rady Children’s Hospital of San Diego (RCHSD), San Diego, California, United States of America Department of Cardiothoracic Surgery, UCSD, San Diego, California, United States of America
Michael Madani
Affiliation:
Department of Cardiothoracic Surgery, UCSD, San Diego, California, United States of America
*
Correspondence to: P. Grossfeld, MD, Division of Pediatric Cardiology, 3020 Children’s Way, MC 5004, San Diego, CA 92123, USA. Tel: 858 966 5855; Fax: 858 571 7903; E-mail: pgrossfeld@ucsd.edu
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Abstract

Objectives

To perform surgical closure of a clinically significant arterial duct on children in a third world country.

Background

An arterial duct is one of the most common congenital cardiac defects. Large arterial ducts can cause significant pulmonary overcirculation, causing symptoms of congestive cardiac failure, ultimately resulting in premature death. Closure of an arterial duct is usually curative, allowing for a normal quality of life and expectancy. In western countries, arterial duct closure in children is usually performed by deployment of a device through a catheter-based approach, replacing previous surgical approaches. In third world countries, there is limited access to the necessary resources for performing catheter-based closure of an arterial duct. Consequently, children with an arterial duct in a third world country may only receive palliative care, can be markedly symptomatic, and often do not survive to adulthood.

Methods

We assembled a team of 11 healthcare workers with extensive experience in the medical and surgical management of children with congenital cardiac disease. In all, 21 patients with a history of an arterial duct were screened by performing a comprehensive history, physical, and echocardiogram at the Angkor Hospital for Children in Siem Reap, Cambodia.

Results

A total of 18 children (eight male and ten female), ranging in age from 10 months to 14 years, were deemed suitable to undergo surgery. All patients were symptomatic, and the arterial ducts ranged in size from 4 to 15 millimetres. Surgical closure was performed using two clips, and in four cases with the largest arterial duct, sutures were also placed. All patients had successful closure without any significant complications, and were able to be discharged home within 2 days of surgery. Of note, four children with arterial ducts died in the 5 months before our arrival.

Conclusion

Surgical closure of an arterial duct can be performed safely and effectively by an experienced paediatric cardiothoracic surgical team on children in a third world country. We hope that our experience will inspire others to perform similar missions throughout the world.

Keywords

Arterial ductligationthird world country
Type
Original Articles
Information
Cardiology in the Young , Volume 20 , Issue 4 , August 2010 , pp. 367 - 372
Copyright
Copyright © Cambridge University Press 2010

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References

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