Which Surgical Approach Is Used For Repair Of Coarctation Of The Aorta And Patent Ductus Arteriosus?

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Amna Qasim, Soham Dasgupta, Sunil K. Jain, Amyn Chiliad. Jiwani, Ashraf K. Aly , "Coarctation of the Aorta as a Complication of Surgical Ligation of Patent Ductus Arteriosus in a Premature Infant", Instance Reports in Pediatrics, vol. 2017 , Article ID 2647353 , 3 pages , 2017 . https://doi.org/10.1155/2017/2647353

Coarctation of the Aorta equally a Complication of Surgical Ligation of Patent Ductus Arteriosus in a Premature Babe

Amna Qasim ,¹ Soham Dasgupta ,¹ Sunil K. Jain ,² Amyn One thousand. Jiwani ,ⁱⁱⁱ and Ashraf M. Aly ³

Academic Editor: Bernhard Resch

Received xvi Feb 2022

Accepted 02 Mar 2022

Published 13 Mar 2022

Surgical ligation of a patent ductus arteriosus (PDA) is a unremarkably performed process. Complications are infrequent and nigh ordinarily include recurrent laryngeal nerve injury and rarely ligation of left pulmonary artery. We written report a case of adventitious ligation of the descending thoracic aorta leading to a clinically meaning coarctation.

one. Introduction

Surgical ligation of patent ductus arteriosus (PDA) is a commonly performed procedure with exceptional complications such as pneumothorax, tears in the ductus arteriosus or the aorta, wound infections, injury of the recurrent laryngeal nerve, and ligation of the left main bronchus or the left pulmonary artery [1]. We report the beginning known case of accidental clipping of the descending aorta leading to a clinically significant coarctation during a surgical ligation of a PDA.

ii. Case Presentation

A premature female infant born at 32 weeks weighing 1,410 grams had a complicated neonatal course that included respiratory distress requiring mechanical ventilation and necrotizing enterocolitis that required exploratory laparotomy and bowel resection. A long systolic murmur was heard at two weeks of life. An echocardiogram revealed a large PDA (left to correct shunt), mild left atrial and left ventricular dilation, and a normal aortic arch. The infant was treated with 2 courses of indomethacin without any response. A chest X-ray showed cardiomegaly and pulmonary congestion consistent with congestive eye failure. Since the patient failed decongestive therapy, surgical ligation of the PDA was performed on mean solar day 18 of life.

A left posterolateral approach was used and the aortic arch, descending aorta, left subclavian artery, vagus nerve, recurrent laryngeal nervus, and PDA were all reported to be visualized clearly. The PDA was ligated with a 10 mm clip after ensuring adequate pre- and postductal saturations. The patient was subsequently noted to accept a loud ejection systolic murmur. The blood force per unit area in the upper extremities was noted to be higher than in the lower extremities (91/65 mmHg versus 77/45 mmHg, resp.). A repeat echocardiogram demonstrated juxtaductal coarctation of the aorta due to impingement of the PDA clip on the descending thoracic aorta (Figure 1 versus Figure ii). The acme velocity was 4.i m/sec and the peak gradient was 68 mmHg. After extensive discussion with the surgical squad, it was decided to monitor the patient clinically with the anticipation that she may need surgery if her condition deteriorates. Follow-up echocardiograms demonstrated depression of the left ventricular systolic function (shortening fraction down to 17%) with dilation of both left atrium and ventricle. At that bespeak, surgical intervention was deemed necessary and the coarctation was corrected with a patch repair technique. Postsurgical echocardiograms revealed improvement in cardiac part (shortening fraction 27–29%) and no rest coarctation. The babe is currently hemodynamically stable from a cardiovascular standpoint.

3. Discussion

A patent ductus arteriosus is necessary during fetal life. The PDA commonly closes spontaneously soon after nativity. The factors that enhance PDA closure include a high oxygen tension and a subtract in endogenous prostaglandins. The incidence of PDA is higher in premature infants. Prostaglandin synthetase inhibitors such every bit indomethacin are commonly used to induce ductal closure in the first ii–4 weeks of life [2]. Symptomatic patients who fail medical management are likely candidates for surgical ligation which is commonly done at the bedside.

Surgical handling has been shown to exist safe and effective, with but occasional complications. The main surgical complications include recurrent laryngeal nerve injury, need for chest tube placement, diaphragmatic paralysis, and wound infections [3]. In that location have been rare reports of ligation of the left main bronchus and/or the left pulmonary artery [4] and nicking of the aorta/ductus arteriosus [5]. Over the years, less invasive transcatheter methods for closure of PDA have been adult. Although this is the preferred method in older children, it may not exist amenable in small premature infants. Common complications of the transcatheter arroyo include embolization and vascular injuries. A large meta-analysis showed that both surgical and transcatheter approaches for PDA closure have comparable outcomes. Reintervention is more common with catheter-based interventions, but overall complexity rates are similar and hospital stay is significantly shorter [vi].

To our knowledge, this is the offset reported instance of accidental clipping of the aorta leading to clinically pregnant coarctation during a surgical ligation of a PDA. The surgical ligation involves meticulous dissection to identify the subclavian artery, descending aorta, distal arch, and ductus before ligation. Smashing care must also be taken to avoid injury to the left recurrent laryngeal nerve. To avoid such injury, surgeons should aim to clip the ductus every bit far abroad from the nerve every bit possible. Coarctation of the aorta may present with hypertension in the upper extremities, headache, lower extremity claudication, and left ventricular hypertrophy. Acute coarctation of the aorta, equally seen after accidental clipping, can potentially lead to spinal arachnoid hemorrhage and lower extremity paraplegia and hypoesthesia as reported in adults [seven].

4. Determination

We report a rare case of accidental clipping of the aorta during surgical ligation of PDA in a premature babe. It is essential that the surgeon is aware of this potential complication. Measurement of pre- and postductal saturations and upper and lower extremity blood force per unit area and performing echocardiography during or immediately later surgery may allow earlier identification of this complication.

Conflicts of Interest

The authors declare that there are no conflicts of interest regarding the publication of this paper.

References

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Copyright

Copyright © 2022 Amna Qasim et al. This is an open access article distributed nether the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.