Annals of African Medicine

RESEARCH ARTICLE
Year
: 2007  |  Volume : 6  |  Issue : 1  |  Page : 34--35

Patent ductus arteriosus in adults: Surgical experience in Ivory-Coast


H Yangni-Angate1, G Ayegnon1, C Meneas1, FL Diby1, Y Yapobi2,  
1 Department of Thoracic and Cardiovascular Surgery, Bouake Teaching Hospital and Institute of Cardiology, Ivory Coast
2 Department of Anaesthesia and Intensive Care, Institute of Cardiology, Abidjan, Ivory Coast

Correspondence Address:
H Yangni-Angate
01bp5119, Abidjan01, Cote D«SQ»Ivoire
Ivory Coast

Abstract

Background : Patent ductus arteriosus surgery is well documented. Hospital Mortality has reduced to almost 0%. Yet, with adults, this surgical cure is likely to be difficult and require some technical skills Method : A retrospective study of surgical procedures and results after surgery of patent ductus arteriosus (PDA) in adults. Results : Since 1978 to 2000 we have reported 16 operated cases. The average age was 22.5 years. There was female predominance with a sex ratio of 2.3/1. All patent ductus arteriosus had been confirmed by two dimensional echocardiography (2D echocardiography) and cardiac catheterization. All hemodynamic types of Nadas classification were observed. Double or triple ligation supported on Teflon felt was the most frequent technique used (69%). This technique gave good results in view of the absence of hospital mortality and only 1 case of recanalisation after a long follow up of all patients from 1 - 7 years (mean 5 years). Conclusion :Double or triple ligation on Teflon felt according to Wright technique is a good technique.



How to cite this article:
Yangni-Angate H, Ayegnon G, Meneas C, Diby F L, Yapobi Y. Patent ductus arteriosus in adults: Surgical experience in Ivory-Coast.Ann Afr Med 2007;6:34-35


How to cite this URL:
Yangni-Angate H, Ayegnon G, Meneas C, Diby F L, Yapobi Y. Patent ductus arteriosus in adults: Surgical experience in Ivory-Coast. Ann Afr Med [serial online] 2007 [cited 2020 Oct 27 ];6:34-35
Available from: https://www.annalsafrmed.org/text.asp?2007/6/1/34/55732


Full Text

 Introduction



Nowadays, patent ductus arteriosus (PDA) surgery is well documented. [1],[2],[3] Hospital mortality is almost approaching zero. [4],[5] Yet, with adults, this surgical cure is likely to be difficult and require some technical skills; [5],[6],[7] particularly, when dealing with calcified, atheromatic or weakened ducts because of strong pulmonary or systemic arterial high blood pressures. [8],[9] This is a report of the experience using ligation on Teflon strip (Wright technique) [10] in adults in Ivory-Coast.

 Material and Methods



From 1977 to 2000, 16 adults were operated upon for PDA at Bouake Teaching Hospital and Institute of Cardiology, Abidjan, Ivory-Coast. There were 10 females and 6 males aged 18– 40 years (mean 22.5 years). Fourteen patients had functional signs of left-right shunt [Table 1] and all the patients had continuous cardiac murmur under the left clavicle.

Chest radiograph showed cardiomegally in 10 patients (mean cardiothoracic ratio 0.53). All patients had evidence of pulmonary hypervascularisation on chest radiographs and 7 had distension of the pulmonary artery. Electrocardiogram (ECG) showed left ventricular hypertrophy in 10 patients. ECG and right cardiac catheterization confirmed diagnosis in all patients. The pulmonary pressures were 15 mmHg - 80 mmHg (mean 27 mmHg). The mean pulmonary pressure was high at 30 mmHg in 4 patients. According to Nadas hemodynamic classification, [6] 5 patients had type I disease, 7 type IIa and 4 type IIb.

The surgical approach was left lower lateral thoracotomy at the level of 4th intercostal space. The surgical procedure consisted of; double or triple ligation of the PDA on Teflon strip (11 patients); suture ligation of the PDA (5 patients). A temporary operating clamping test of the ductus arteriosus was carried out in one patient; this patient had a bidirectional shunt with left predominance and mean systemic pulmonary pressure of 80 mmHg. Good tolerance of the clamping allowed triple ligation on Teflon strip to proceed.

 Results



Immediate

There was no hospital mortality. Post operative course was uneventful in all 16 patients.

Late

Every patient was reexamined and follow up was 1– 7 years. Recanalisation was noticed in one patient who had triple ligation on Teflon strip; subsequent suture ligation was successful.

 Discussion



The double or triple ligation on Teflon strip as described by Wright [10] is our first surgical option for the treatment of PDA in adults. The technique is less expensive, achievable, less traumatizing, and is quicker to perform. It is efficient and carries no hospital mortality. The utility and effectiveness of this procedure has been demonstrated in a series of 145 children with PDA in Ivory-Coast.

Suture ligation [2] is another technique carried out with close-heart surgery. It was used on 5 patients in the present report. In adults, using suture ligation requires particular caution as the PDA is sometimes fragile at this age. [3],[7] This fragility is so acute that there is a high pulmonary or systemic arterial blood pressure. [7] Furthermore, it may become necessary to resort to a cardio-pulmonary bypass when haemostasis becomes difficult to achieve. For these reasons, suture ligation is not our first surgical option. We prefer to use this technique when there is no high systemic arterial blood pressures and /or when there are normal or moderately high pulmonary pressures.

Techniques requiring the use of cardio-pulmonary bypass are expensive and not always suitable in our setting.

Ligation on Teflon strip can be safely used for treatment of PDA in adults. This method is so useful that it can be applicable in every surgical centre in Africa where open-heart surgeries are not carried out.

References

1Goor AD, Lillehei WC. Patent ductus arteiosus. In: Congenital malformations of the heart. Grune and Straton, New York, 1975; 340– 351
2Kirkun JW, Barrat-Boyes BG. Patent ductus arteriosus. In: Cardiac surgery. Churchill Livingstone, New York, 1993; 841– 859
3Rampha LPS, Irvine R, Spencer HW. Surgery for patent ductus arteriosus still the gold standard. West Indian Med J 2000; 4: 294– 297
4Zhonghua WZZ. Long-term results of surgical treatment of patent ductus arteriosus in adults. Chinese Journal of Surgery 1993; 31: 431– 432
5Aghaji MAC, Ojimba TA. Review of 322 cases of ductal surgery in Enugu. Tropical Cardiology 1993; 19: 113– 116
6Guilmet D, Soyer R, Brunet A, Gandjbakhch J, Dubost CH. Cure Chirurgicale du canal arteriel avec hypertension pulmonaire par voie endoaortique sous assistance circulatoire. Cœur 1971 ; 2 : 389-398
7John S, Murcidharam S, Jairaj PS, et al. The adult ductus: review of surgical experience with 131 patients. J Thorac Cardiovasc Surg 1981; 82: 314– 319
8Pavie A, Msika S, Mussat T, et al. Traitement chirurgical du canal artériel de l'adulte. Arch Mal Coeur 1983 ; 12 : 1431-1436
9Cellemajer DS, Sholler GF, Hughes CF, Baird DK. Persistent ductus arteriosus in adults. A review of surgical experience with 25 patients. Med J Aust 1991; 4: 233 - 236
10Wright JS, Newman DC. Ligation of the patent ductus. J Thorac Cardiovasc Surg 1978; 75: 695– 698