Images in Clinical Medicine

Thoracoscopic Clipping of Patent Ductus Arteriosus

Redmond P. Burke, M.D., and Gil Wernovsky, M.D.

N Engl J Med 1997; 336:185January 16, 1997

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Figure 1 A continuous murmur heard on the 10th day of life in a 590-g infant delivered at 25 weeks' gestation led to the diagnosis of patent ductus arteriosus. The child had numerous medical problems, including hyaline membrane disease, renal dysfunction, sepsis, and intraventricular hemorrhages. High inspired-oxygen concentrations, high airway pressures, and inotropic support were required. A video-assisted thoracoscopic approach was used because the ductus did not close after treatment with indomethacin and the child was too small for a transcatheter procedure. A 4-mm video camera was placed in the left pleural space through a small stab wound (Panel A). Operating instruments were inserted through separate small puncture wounds, and the patent ductus arteriosus (PDA) was dissected free (Panel B). A clip was advanced through a 4-mm incision and placed around the duct (Panel C). After surgery the need for high inspired-oxygen concentrations and high airway pressures immediately decreased, and inotropic agents were discontinued after two days. Four months postoperatively, the child had gained weight and his condition had improved markedly. LSA denotes left subclavian artery.

Redmond P. Burke, M.D.
Miami Children's Hospital, Miami, FL 33155

Gil Wernovsky, M.D.
Children's Hospital of Philadelphia, Philadelphia, PA 19104

Citing Articles (5)

Citing Articles

1. 1

   Pedro J. del Nido. (2007) Minimal Incision Congenital Cardiac Surgery. Seminars in Thoracic and Cardiovascular Surgery 19:4, 319-324
   CrossRef

2. 2

   Jeffrey P Jacobs, Jorge M Giroud, James A Quintessenza, Victor O Morell, Luis M Botero, Hugh M van Gelder, Vinay Badhwar, Redmond P Burke. (2003) The modern approach to patent ductus arteriosus treatment: complementary roles of video-assisted thoracoscopic surgery and interventional cardiology coil occlusion. The Annals of Thoracic Surgery 76:5, 1421-1428
   CrossRef

3. 3

   Kagami Miyaji, Robert L Hannan, Jorge Ojito, James M Dygert, Jeffrey A White, Redmond P Burke. (2000) Video-assisted cardioscopy for intraventricular repair in congenital heart disease. The Annals of Thoracic Surgery 70:3, 730-737
   CrossRef

4. 4

   Redmond P. Burke. (1999) Minimally invasive pediatric cardiac surgery. Current Opinion in Cardiology 14:1, 67
   CrossRef

5. 5

   (1997) Literature Watch. Pediatric Endosurgery & Innovative Techniques 1:3, 205-208
   CrossRef