Ductal closure by small thoracotomy in premature infants less than 1500gm

초록

Background: Lessening surgical trauma is very important in the operation of the premature and very low birth weight babies who often have various co-morbidites in addition to inherent problem of prematurity. We have adopted subaxillary mini-thoracotomy instead of conventional posterolateral thoracotomy for the PDA closure in very low birth weight infants and the clinical results were analyzed. Material and Method: From April 2002 to January 2008, 33 premature infants whose gestation was under 37 weeks underwent surgical closure of the patent ductus arteriosus at the discretion of neonatologist and pediatric cardiologist. The mean gestational age was 28 weeks ranging from 23+3 to 33+0 weeks and the average age at operation was 16.9±9.1 days. The mean body weight at operation was 959g ranging from 490 to 1460g; 22 infants were under 1000g. Twenty four infants were ventilator dependent preoperatively. The procedures were performed in the newborn intensive care unit via 2cm long subaxillary mini-thoracotomy in lateral position with left arm abduction. The mean size of the patent ductus arteriosus was 3.5±0.6mm. For the most part, the ductus was closed with titanium clips; 3 infants in whom the ductus was ruptured while on dissection underwent ductal division. Result: Five infants died after the operation; All mortalities were from the infant’s inherent problem of prematurity and co-morbidities, not related to the operation itself. In most cases, hemodynamic instability and respiratory distress were rapidly improved after the procedure, thus enabling early ventilator weaning and easier volume management. Mean postoperative duration of ventilator support in the group of infants who had been ventilator-dependent preoperatively was 13.0±19.3 days. Wound infection developed in one infant postoperatively. Conclusion: Considering low surgical risk along with less invasiveness of subaxillary mini-thoracotomy, early and aggressive surgical intervention is highly recommended.