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Results Of Surgical Ligation in Preterm infants With Hemodynamically Significant Patent Ductus Arteriosus

Year 2014, Volume: 11 Issue: 3, 85 - 89, 01.07.2014

Abstract

Aim: Surgical ligation is treatment option in preterm infants with hemodynamically significant patent ductus arteriosus who are unresponsive to medical closure. We aimed to retrospectively evaluate preterms in whom surgical ligation was performed for hemodynamically significant patent ductus arteriosus between January 2007 and February 2012. Material and Methods: In our unit surgical ligation is beeing performed for hemodynamically significant patent ductus arteriosus in preterms who are unresponsive to medical closure or in whom it is contraindicated. The medical records of 34 preterm infants were retrospectively evaluated. Data related to demographic features, mode of respiratory support, need and duration of oxygen support, presence of intraventricular hemorrhage, bronkopulmonary displasia and acute renal failure, duration of hospital stay and mortality were recorded. Results: Median postnatal age at operation was 30 days 7-90 days . A total of 10 patients 29.4% died after operation. Twenty-four patients were discharged. Two deaths were related to surgical complications. Nine of twenty-four 37.5% discharged patients had need for oxygen support. All discharged patients escaped from oxygen support at median 18 postoperative 1-160 days days. When adjusted for gestational age and birth weight, operation day before 28th postnatal days and after 28th postnatal days did not affect the mortality and the need for oxygen support at discharge. Conclusion: It seems that surgical ligation is a good treatment option in preterm infants with hemodynamically significant patent ductus arteriosus who are unresponsive to medical closure. Our results indicate that the operation day 28th postnatal days does not affect the mortality and the need for oxygen support at discharge.

References

  • Cotton RB, Stahlman MT, Kovar I, et al. Medical management of small preterm infants with symptomatic patent ductus arteriosus. J Pediatr 1978;92:467–73.
  • Hsiao CC, Wung JT, Tsao TY, Chang WC. Early or late surgical ligation of medical refractory patent ductus arteriosus in premature infants. J Formos Med Assoc 2009;108:72-7.
  • Sİrensen CM, Steensberg JN, Greisen G. Surgical ligation of patent ductus arteriosus in premature infants. Dan Med Bull. 2010;57(6):A4160.
  • Dani C. New therapeutic strategies for the treatment of patent du- ctus arteriosus in preterm infants. J Matern Fetal Neonatal Med. 2011 Nov;24
  • Raval MV, Laughon MM, Bose CL and Phillips JD.Patent ductus arteriosus ligation inpremature infants:who really benefits, and at what cost? J Pediatr Surg2007; 42: 69–75.
  • Truog WE, Jackson C, Badura RJ, Sorensen GK, Murphy JH and Woodrum DE. Bronchopulmonary dysplasia and pulmonary insuf- ficiency of prematurity. Lack of correlation of outcome with gas exchange abnormalities at 1 month of age. Am J Dis Child 1985; 139: 351–4.
  • Tantraworasin A, Woragidpoonpol S, Chuaratanapong S, Sittiwan- gkul R, Chittawatanarat K.Timing of surgical closure of patent duc- tus arteriosus in preterm neonates? Asian Cardiovasc Thorac Ann. 2012;20:12-8.
  • Vida VL, Lago P, Salvatori S, Boccuzzo G, Padalino MA, Milanesi O, et al. Is there an optimal timing for surgical ligation of patent ductus arteriosus in preterm infants? Ann Thorac Surg 2009; 87: 1509–16.
  • Kabra N, Schmidt B, Roberts R, et al. Surgical closure of a patent ductusarteriosus (PDA) is associated with increased neurosensory impairment in extremely low birth weight (ELBW) infants. J Pediatr. 2007;150:229-34.
  • Friedman WF, Hirschklau MJ, Printz MP, et al. Pharmacologic clo- sure of patent ductus arteriosus in the premature infant. N Engl J Med 1976;295:526–9.
  • Jaillard S, Larrue B, Rakza T et al. consequences of delayed sur- gical closure of patent ductus arteriosus in very premature infants. Ann Thorac Surg 2006;81:231-5.
  • Perez CA, Bustorff-Silva JM, Villasenor E, et al. Surgical ligation of patent ductus arteriosus in very low birth weight infants: is it safe? Am Surg 1998;64:1007–9.
  • Ekici F, Atasay B, Günlemez A, Naçar N, Tutar E, Atalay S, Eyile- ten Z, Uysalel A, Arsan S. Management of patent ductus arteriosus in preterm infants. Anadolu Kardiyol Derg. 2006;6:28-33.
  • Vuran C, Ayabakan C, Yörüker U, Özker E, Sarıtaş B, Günaydın Ç, Türköz A, Paketci C, Sarısoy Ö, Omay O, Tokel K, Türköz R. Günübirlik cerrahi girişim ile patent duktus arteriyozusu bağlanan 20 düşük ağırlıklı erken doğmuş bebekte cerrahi tedavi ve ameliyat sonrası izlem sonuçları. Türk Ped Arş 2011; 46: 124-8.
  • ArmangilD, Yurdakök M, Karagöz T, Canpolat FE, Korkmaz A, Yi- ğit Ş, Tekinalp G. Yenidoğan yoğun bakım ünitesinde patent duktus arteriozus ligasyonu yapılan prematüre bebeklerin retrospektif in- celenmesi Çocuk Sağlığı ve Hastalıkları Dergisi 2008; 51: 187-192
  • Malviya MN, Ohlsson A, Shah SS. Surgical versus medical treat- ment with cyclooxygenase inhibitors for symptomatic patent ductus arteriosus in preterm infants.Cochrane Database Syst Rev. 2013 Mar 28;3:CD003951.
  • Knight DB. The treatment of patent ductus arteriosus in preterm in- fants. A review and overview of randomized trials. Semin Neonatol 2001;6:63-73.
  • Madan JC, Kendrick D, Hagadorn JI et al. Patent ductus arteriosus therapy: impact on neonatal and 18-month outcome. Pediatrics 2009;123:674-81.
  • Lee L, Tillet A, Tulloh R et al. Outcome following patent ductus arte- riosus ligation in premature infants: a retrospective cohort analysis. BMC Pediatrics 2006;6:15.
  • Lin YC, Huang HR, Lien R, Yang PH, Su WJ, Chung HT, Chen TJ, Liu WH. Management of patent ductus arteriosus in term or near-term neonates with respiratory distress. Pediatr Neonatol. 2010;51:160-5.

Semptomatik Patent Duktus Arteriozuslu Prematüre Bebeklerde Cerrahi Ligasyon Sonuçları

Year 2014, Volume: 11 Issue: 3, 85 - 89, 01.07.2014

Abstract

Amaç: Hemodinamik olarak önemli patent duktus arteriozus tedavisinde medikal kapatma tedavisine cevap vermeyen hastalarda cerrahi ligasyon tedavi seçeneği olarak görünmektedir. Kliniğimizde Ocak 2007 Şubat 2012 tarihleri arasında duktus arteriozusu cerrahi olarak kapatılan hastaların sonuçlarının retrospektif olarak değerlendirilmesi amaçlanmıştır.Yöntemler: Yenidoğan Yoğun Bakım Kliniği’nde Hemodinamik olarak önemli patent duktus arteriozus tanısı alan bebeklerden medikal tedaviye yanıt alınamayan veya kontrendike olduğundan medikal tedavi verilemeyen bebeklere cerrahi ligasyon uygulandı. Toplam 34 preterm bebeğin kayıtları retrospektif olarak incelendi. Demografik özellikler, ameliyat öncesi ve sonrası solunum desteği, oksijen ihtiyacı ve süresi, intraventriküler kanama, bronkopulmoner displazi, akut böbrek yetmezliği, hastanede kalış süresi ve mortalite verileri kaydedildi.Bulgular: Ameliyat edilme yaşı postnatal ortanca 30 7-90 gün idi. Ameliyat sonrası toplam on hasta %29.4 kaybedilirken, 24 hasta taburcu edilebildi. Ölenlerden İkisi cerrahi komplikasyonlar nedeniyle kaybedildi. Yaşayan 24 hastadan 9’unun %37.5 taburculukta oksijen ihtiyacı vardı. Taburcu edilebilen tüm hastalar ameliyat sonrası ortanca 18 günde 1-160 oksijen desteğinden kurtuldu. Regresyon analizi, ameliyatın postnatal 28. günden önce veya sonra yapılmış olmasının taburculukta oksijen ihtiyacının olup olmamasını ve mortaliteyi etkilemediğini ortaya koydu.Somuç: Sonuç olarak medikal tedaviye cevap vermeyen Hemodinamik olarak önemli patent duktus arteriozuslu prematüre bebeklerde cerrahi tedavi uygulanabilir bir yöntem olarak görülmektedir. Çalışma sonuçlarımız cerrahi tedavinin 28 günden önce yapılmasının mortalite ve taburculukta oksijen desteği ihtiyacı üzerine etkisi olmadığına işaret etmektedir.

References

  • Cotton RB, Stahlman MT, Kovar I, et al. Medical management of small preterm infants with symptomatic patent ductus arteriosus. J Pediatr 1978;92:467–73.
  • Hsiao CC, Wung JT, Tsao TY, Chang WC. Early or late surgical ligation of medical refractory patent ductus arteriosus in premature infants. J Formos Med Assoc 2009;108:72-7.
  • Sİrensen CM, Steensberg JN, Greisen G. Surgical ligation of patent ductus arteriosus in premature infants. Dan Med Bull. 2010;57(6):A4160.
  • Dani C. New therapeutic strategies for the treatment of patent du- ctus arteriosus in preterm infants. J Matern Fetal Neonatal Med. 2011 Nov;24
  • Raval MV, Laughon MM, Bose CL and Phillips JD.Patent ductus arteriosus ligation inpremature infants:who really benefits, and at what cost? J Pediatr Surg2007; 42: 69–75.
  • Truog WE, Jackson C, Badura RJ, Sorensen GK, Murphy JH and Woodrum DE. Bronchopulmonary dysplasia and pulmonary insuf- ficiency of prematurity. Lack of correlation of outcome with gas exchange abnormalities at 1 month of age. Am J Dis Child 1985; 139: 351–4.
  • Tantraworasin A, Woragidpoonpol S, Chuaratanapong S, Sittiwan- gkul R, Chittawatanarat K.Timing of surgical closure of patent duc- tus arteriosus in preterm neonates? Asian Cardiovasc Thorac Ann. 2012;20:12-8.
  • Vida VL, Lago P, Salvatori S, Boccuzzo G, Padalino MA, Milanesi O, et al. Is there an optimal timing for surgical ligation of patent ductus arteriosus in preterm infants? Ann Thorac Surg 2009; 87: 1509–16.
  • Kabra N, Schmidt B, Roberts R, et al. Surgical closure of a patent ductusarteriosus (PDA) is associated with increased neurosensory impairment in extremely low birth weight (ELBW) infants. J Pediatr. 2007;150:229-34.
  • Friedman WF, Hirschklau MJ, Printz MP, et al. Pharmacologic clo- sure of patent ductus arteriosus in the premature infant. N Engl J Med 1976;295:526–9.
  • Jaillard S, Larrue B, Rakza T et al. consequences of delayed sur- gical closure of patent ductus arteriosus in very premature infants. Ann Thorac Surg 2006;81:231-5.
  • Perez CA, Bustorff-Silva JM, Villasenor E, et al. Surgical ligation of patent ductus arteriosus in very low birth weight infants: is it safe? Am Surg 1998;64:1007–9.
  • Ekici F, Atasay B, Günlemez A, Naçar N, Tutar E, Atalay S, Eyile- ten Z, Uysalel A, Arsan S. Management of patent ductus arteriosus in preterm infants. Anadolu Kardiyol Derg. 2006;6:28-33.
  • Vuran C, Ayabakan C, Yörüker U, Özker E, Sarıtaş B, Günaydın Ç, Türköz A, Paketci C, Sarısoy Ö, Omay O, Tokel K, Türköz R. Günübirlik cerrahi girişim ile patent duktus arteriyozusu bağlanan 20 düşük ağırlıklı erken doğmuş bebekte cerrahi tedavi ve ameliyat sonrası izlem sonuçları. Türk Ped Arş 2011; 46: 124-8.
  • ArmangilD, Yurdakök M, Karagöz T, Canpolat FE, Korkmaz A, Yi- ğit Ş, Tekinalp G. Yenidoğan yoğun bakım ünitesinde patent duktus arteriozus ligasyonu yapılan prematüre bebeklerin retrospektif in- celenmesi Çocuk Sağlığı ve Hastalıkları Dergisi 2008; 51: 187-192
  • Malviya MN, Ohlsson A, Shah SS. Surgical versus medical treat- ment with cyclooxygenase inhibitors for symptomatic patent ductus arteriosus in preterm infants.Cochrane Database Syst Rev. 2013 Mar 28;3:CD003951.
  • Knight DB. The treatment of patent ductus arteriosus in preterm in- fants. A review and overview of randomized trials. Semin Neonatol 2001;6:63-73.
  • Madan JC, Kendrick D, Hagadorn JI et al. Patent ductus arteriosus therapy: impact on neonatal and 18-month outcome. Pediatrics 2009;123:674-81.
  • Lee L, Tillet A, Tulloh R et al. Outcome following patent ductus arte- riosus ligation in premature infants: a retrospective cohort analysis. BMC Pediatrics 2006;6:15.
  • Lin YC, Huang HR, Lien R, Yang PH, Su WJ, Chung HT, Chen TJ, Liu WH. Management of patent ductus arteriosus in term or near-term neonates with respiratory distress. Pediatr Neonatol. 2010;51:160-5.
There are 20 citations in total.

Details

Primary Language Turkish
Journal Section Research Article
Authors

Kadir Şerafettin Tekgündüz This is me

Naci Ceviz This is me

İbrahim Caner This is me

Haşim Olgun This is me

Necip Becit This is me

Abdurrahim Çolak This is me

Publication Date July 1, 2014
Published in Issue Year 2014 Volume: 11 Issue: 3

Cite

Vancouver Tekgündüz KŞ, Ceviz N, Caner İ, Olgun H, Becit N, Çolak A. Semptomatik Patent Duktus Arteriozuslu Prematüre Bebeklerde Cerrahi Ligasyon Sonuçları. JGON. 2014;11(3):85-9.