Repair Of Patent Ductus Arteriosus

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was done The thorax was entered through the third intercostal space /the fourth intercostal space The left lung was retracted medially, with taking care not to compromise ventilation or cardiac output any more than necessary.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