Comparison of the Early Results of Preterm Infants who Underwent the Surgical Ligation of Patent Ductus Arteriosus with two Different Surgical Approaches

INTRODUCTION: Patent ductus arteriosus (PDA) is the most common congenital heart disease in preterm infants. Surgical ligation is still the gold standard technique, especially in low birth weight patients. To reduce surgical trauma and possible complications, the anterior mini-thoracotomy (AMT) technique has been defined. However, conventional lateral thoracotomy (LT) is still the method preferred by many centers today. In our study, we aimed to compare the early results of preterm infants who underwent PDA ligation with two different surgical techniques in a newly established center. METHODS: A total of 26 patients (12 males, 14 females; median gestational age at surgery 32 weeks [IQR: 29-37]) who underwent surgical PDA ligation in preterm infants between January 2018 and February 2020 were retrospectively analyzed. PDA closure was performed through the left anterior mini-thoracotomy approach in 15 of the patients and left lateral thoracotomy in 11 patients. The early outcomes of the two groups were compared. RESULTS: The median weight at operation was 1000 gr. (IQR: 720-1200) in AMT group and 1200 gr. (IQR: 1000 – 2800) in the LT group. The difference between weights at operation was found statistically significant (p: 0.03). The operation time of the AMT group was found to be statistically significantly shorter. (p: 0.03) DISCUSSION AND CONCLUSION: Anterior mini-thoracotomy technique provides an effective surgical closure in the low-weight preterm infant at least lateral thoracotomy technique. Based on the results of our series and our opinion, it should be considered the first choice surgical method, especially in very low and extremely low-weight preterm infants

Right Juxtaposition and a Tunnel Between the Atrial Appendages in a Patient With Atrial Septal Defect and Pulmonary Valve Stenosis

A 13-month-old boy with a diagnosis of atrial septal defect and pulmonary valve stenosis was admitted for corrective surgery. Right juxtaposition of the atrial appendages with a tunnel between the atrial appendages was detected during the surgery. The patient was operated successfully and had an uneventful recovery. Once right juxtaposition of the atrial appendages has been identified, the possibility of a "tunnel'' communication between the appendages must be considered and ruled out

A Complication following the Transcatheter Closure of a Muscular Ventricular Septal Defect

Today, congenital heart diseases may be treated without surgery through advances in interventional cardiology. However, complications such as infection and thrombus formation may develop due to foreign materials used during these procedures. Surgical intervention may be required for the removal of the device utilized for the procedure. In this case report, we present the surgical treatment of a residual ventricular septal defect (VSD) that had developed in a 6-year-old patient with an apical muscular VSD closed with the Amplatzer muscular VSD device. The patient was admitted to the emergency room with complaints of abdominal pain and high fever 5 days after discharge without any cardiac symptoms. When she arrived at our clinic, she had a heart rate of 95 bpm, blood pressure of 110/70 mmHg, and temperature of 38.5ºC. Examinations of the other systems were normal, except for a 3/6 pan-systolic murmur at the mesocardiac focus on cardiac auscultation. Echocardiography showed a residual VSD, and the total pulmonary blood flow to the total systemic blood flow ratio (Qp/Qs) of the residual VSD was 1.8. In the operating room, the Amplatzer device was removed easily with a blunt dissection. The VSD was closed with an autologous fresh pericardial patch. Following the pulmonary artery debanding procedure, the postoperative period was uneventful. The condition of the patient at the time of discharge and in the first postoperative month’s follow-up was good. There was no residual VSD or infection.