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

  • Paul Grossfeld (a1) (a2), Mark Greenberg (a3), Sandra Saw (a4), Gloria Cheng (a3), Anthony Stanzi (a4), James Mathewson (a5), Ngeth Pises (a6), Luy Lyda (a6), Sar Vuthy (a7), William Elias (a1) (a2), Stephanie Moriarty (a2), Sharon Levy (a2), Deborah Walter (a2), Phillip Panzarella (a8), Susan Grossfeld (a2), Jolene Kriett (a2) (a9) and Michael Madani (a9)...

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.

Copyright

Corresponding author

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

References

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1. Mullins, C, Pagotto, L . In Garson A, Bricker JT, Fisher D, Neish S (eds). The Science and Practice of Pediatric Cardiology. Williams and Wilkins, Philadelphia, Pennsylvania, 1989, 1181–1198.
2. Satoda, M, Zhao, F, Diaz, GA, et al. Mutations in TFAP2B cause Char syndrome: a familial form of patent ductus arteriosus. Nat Genet 2000; 25: 4246.
3. Celermajer, DS, Sholler, GF, Hughes, CF, Baird, DK. Persistent ductus arteriosus in adults. A review of surgical experience with 25 patients. Med J Aust 1991; 155: 233236.
4. Moore, JW, George, L, Kirkpatrick, SE, et al. Percutaneous closure of the small patent ductus arteriosus using occluding spring coils. J Am Coll Cardiol 1994; 23: 759765.
5. Burke, RP, Wernovsky, G, van der Velde, M, Hansen, D. Castaneda ARVideo-assisted thoracoscopic surgery for congenital heart disease. J Thorac Cardiovasc Surg 1995; 109: 499507; discussion 508.

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