REPAIR OF PATENT DUCTUS ARTERIOSUS

REASON FOR VISIT

• Patent ductus arteriosus

• Heart murmur
• Fatigue
• Sweating
• Rapid breathing
• Heavy breathing
• Congested breathing
• Disinterest in feeding, or tiring while feeding
• Poor weight gain

RISK ASSESSMENT

• Premature baby
• Low birth weight
• severe pulmonary vascular disease
• Pulmonary artery hypoplasia
• Pulmonary atresia
• Tricuspid atresia
• Transposition of the great arteries
• Aortic valve atresia
• Mitral valve atresia with hypoplastic left ventricle
• Severe coarctation of the aorta

PREPARATION OF THE PATIENT:

• Blood tests
• Urine tests
• Chest radiograph
• ECG or EKG
• 2D-echo
• Angiography
• Cardiac catheterization
• CT scan
• MRI
• Nothing is taken by mouth 6hrs before surgery
• Antibiotics were given

POSITION OF THE PATIENT:

Right lateral decubitus position with the left arm extended above the
head.

ANESTHESIA:
General anesthesia

THE PROCEDURE:

• Patient was positioned in right lateral decubitus position with the

left arm extended above the head
• Left lateral posterior thoracotomy was done
• The thorax was entered through the third intercostal space /the
fourth intercostal space
• The left lung was retracted medially, with taking care not to
compromise ventilation or cardiac output any more than
necessary.
• The mediastinal pleura retracted over the descending aorta and
proximal subclavian artery was incised and retracted medially
• Meticulous dissection was performed
• The left recurrent laryngeal nerve was identified and preserved
• The patent ductus was identified and it was in size _____.
• It was isolated and ligated with silk suture /stainless steel clips,
• Several ties / clips were used.
• The mediastinal pleura was closed
• Chest tube was placed
• Skin was sutured

AFTER PROCEDURE

• Patient was shifted to the I.C.U

• Patient was on ventilation
• Heart sounds, oxygenation, and the ECG were monitored.
• Chest tubes are checked to ensure that they're draining
properly and there is no hemorrhage.
• The skin around the drainage tube to the thoracic cavity kept
clean, and the tube must be kept unblocked

DURATION
_____________hrs

POSTOPERATIVE CARE
 • Take antibiotic medicine as prescribed
• Take pain medication
• Start chest exercises and chest physical therapy

COMPLICATIONS

• Incomplete closure
• recanalization
• Bleeding
• Pneumothorax
• Injured recurrent laryngeal nerve
• Chylothorax as a result of thoracic duct injury
• Rare ligation of nonductal tissue
• Residual shunting
• Vocal cord paralysis