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KMID : 0371319700120050001
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Journal of the Korean Surgical Society
1970 Volume.12 No. 5 p.1 ~ p.10
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Surgical Treatment of Patent ductus Arteriosus
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柳會性/Yoo, Hoe Sung
朱宅昭/李浩一/金種欣/Choo, Taik So/Lee, Ho Il/Kim, Jong-Heun
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Abstract
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Patent ductus arteriousus is now the most favorable prognostic congenital cardiac malformation after achievement of its surgical correction by Gross in 1938. However, there still remains some problems in surgical view points in complicated cases such as the one with pulmonary hypertension, congestive heart failure, bacterial endocarditis, aneurysm of the ductus, and so-called malignant patent ductus arteriosus etc.
During the period of January, 1960, to December, 1967, the authors experienced 51 cases of patent ductus arteriosus in Thoracic Surgery Department of the National Medical Center, Seoul and obtained the following results from the series.
1) Patent ductus arteriosus was found to be the second most frequent congenital cardiac malformation (30.9%) after tetralogy of Fallot during the period.
2) More than 70 per cent was under 10 years of age and female predominated with the ratio of 2.9:1.
3) Chief complaints on admissiond were exertional dyspnea in 42 cases, papitation in 29 and easy fatigability in 15 cases and 36 cases had history of frequent upper respiratory tract infections.
4) Typical contineous machinary murmur noted in 45 cases and systolic murmur in 6 cases at pulmonic area and thrill was palpated in all cases. Fourteen had hepatomegaly and 7 had signs of congestive heart failure on admission. 88 per cent had wide pulse pressure over 50 mm Hg and mean pulse pressure was 67.4 mm Hg.
5) Diagnosis was made on the basis of physical findings in typical 45 cases, and by retrograde aortography and right heart catheterization in remaining 6 cases of which one had so-called reverse shunt.
6) Any combined cardiovascular anomalies were not encountered in the series but 3 extracardiac malformations that are 2 of strabismus and one of inguinal hernia, and subacute bacterial endocarditis was complicated in 2 cases.
7) 47 cases had increased cardiac index, and 45 had increased peripheral pulmonary vascularity on plain chest films.
8) 90 per cent of the series had normal axis and 66 per cent showed vertical heart position on standard leads and limb leads of electrocardiography. 60 per cent had tall T wave in V_(4∼6) on precordial leads and 84 per cent of patients showed left venticular hypertrophy pattern of various degree.
9) Preoperatively, intense medical treatment was given in cases of congestive heart failure and subacute bacterial endocarditis. Sensitive antibiotics were given in cases with subacute bacterial endoacrditis for 3 weeks in one and 8 weeks for the other till obtaining negative symptomatology and negative blood cultures on 2 or 3 occasions.
10) Division of ductus was made in 32 cases and multiple ligation in remaining 18 cases, and no operation in one case who had reverse shunt.
11) Immediate postoperative complications were 3 of aspiration pneumenitis, 3 of transient hoarseness without vocal cord paralysis, 2 of laryngeal edema and one of transient motor paralysis of the right arm due to compression during operation. 2 cases died of irreversible brain damage by hypoxia due to anesthetic complication and these expired cases had moderate to severe pulmonary hypertension preoperatively.
12) Survived 48 cases showed excellent results of operation with marked reduction of pulse pressure, radiologic changed and symptomatologic improvement including immediate electrocardiographic changes in some cases.
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