Describe Surgical Closure of Patent Ductus Arteriosus technique?
The patient is positioned in right lateral position and a left posterolateral thoracotomy is done. In infants and children only a small lateral thoracotomy is required. The chest is opened through fourth intercostal space. A chest retractor is applied and lung retracted anteriorly. Mediastinal pleura is incised over descending aorta, arch and on to the left subclavian artery. Flaps are raised and stay sutures taken. Under controlled hypotension, the ductus is dissected and isolated. Small ductus can be ligated. Triple ligation is done with two ligatures at aortic and pulmonary ends. In between a transfixion suture is applied. The other technique is division and suture. Between two clamps, ductus is divided and aortic and pulmonary ends are sutured with 6 or 5 '0' prolene sutures. In large short ductus which is more like an aorta pulmonary window in the ductal position it is better to clamp the aorta above and below the ductus and a third clamp on the pulmonary arterial end. Ductus is divided. Aortic end is sutured with 5 '0' prolene and clamps removed. Aortic clamping time should be limited to 15 minutes and definitely not more than 20 minutes.