TY - JOUR
T1 - Successful surgical closure of an arterial duct in 18 children in a third world country
AU - Grossfeld, Paul
AU - Greenberg, Mark
AU - Saw, Sandra
AU - Cheng, Gloria
AU - Stanzi, Anthony
AU - Mathewson, James
AU - Pises, Ngeth
AU - Lyda, Luy
AU - Vuthy, Sar
AU - Elias, William
AU - Moriarty, Stephanie
AU - Levy, Sharon
AU - Walter, Deborah
AU - Panzarella, Phillip
AU - Grossfeld, Susan
AU - Kriett, Jolene
AU - Madani, Michael
PY - 2010/8
Y1 - 2010/8
N2 - Objectives To perform surgical closure of a clinically significant arterial duct on children in a third world country.Background An arterial duct is one of the most common congenital cardiac defects. Large arterial ducts can cause significant pulmonary overcirculation, causing symptoms of congestive cardiac failure, ultimately resulting in premature death. Closure of an arterial duct is usually curative, allowing for a normal quality of life and expectancy. In western countries, arterial duct closure in children is usually performed by deployment of a device through a catheter-based approach, replacing previous surgical approaches. In third world countries, there is limited access to the necessary resources for performing catheter-based closure of an arterial duct. Consequently, children with an arterial duct in a third world country may only receive palliative care, can be markedly symptomatic, and often do not survive to adulthood.Methods We assembled a team of 11 healthcare workers with extensive experience in the medical and surgical management of children with congenital cardiac disease. In all, 21 patients with a history of an arterial duct were screened by performing a comprehensive history, physical, and echocardiogram at the Angkor Hospital for Children in Siem Reap, Cambodia.Results A total of 18 children (eight male and ten female), ranging in age from 10 months to 14 years, were deemed suitable to undergo surgery. All patients were symptomatic, and the arterial ducts ranged in size from 4 to 15 millimetres. Surgical closure was performed using two clips, and in four cases with the largest arterial duct, sutures were also placed. All patients had successful closure without any significant complications, and were able to be discharged home within 2 days of surgery. Of note, four children with arterial ducts died in the 5 months before our arrival.Conclusion Surgical closure of an arterial duct can be performed safely and effectively by an experienced paediatric cardiothoracic surgical team on children in a third world country. We hope that our experience will inspire others to perform similar missions throughout the world.
AB - Objectives To perform surgical closure of a clinically significant arterial duct on children in a third world country.Background An arterial duct is one of the most common congenital cardiac defects. Large arterial ducts can cause significant pulmonary overcirculation, causing symptoms of congestive cardiac failure, ultimately resulting in premature death. Closure of an arterial duct is usually curative, allowing for a normal quality of life and expectancy. In western countries, arterial duct closure in children is usually performed by deployment of a device through a catheter-based approach, replacing previous surgical approaches. In third world countries, there is limited access to the necessary resources for performing catheter-based closure of an arterial duct. Consequently, children with an arterial duct in a third world country may only receive palliative care, can be markedly symptomatic, and often do not survive to adulthood.Methods We assembled a team of 11 healthcare workers with extensive experience in the medical and surgical management of children with congenital cardiac disease. In all, 21 patients with a history of an arterial duct were screened by performing a comprehensive history, physical, and echocardiogram at the Angkor Hospital for Children in Siem Reap, Cambodia.Results A total of 18 children (eight male and ten female), ranging in age from 10 months to 14 years, were deemed suitable to undergo surgery. All patients were symptomatic, and the arterial ducts ranged in size from 4 to 15 millimetres. Surgical closure was performed using two clips, and in four cases with the largest arterial duct, sutures were also placed. All patients had successful closure without any significant complications, and were able to be discharged home within 2 days of surgery. Of note, four children with arterial ducts died in the 5 months before our arrival.Conclusion Surgical closure of an arterial duct can be performed safely and effectively by an experienced paediatric cardiothoracic surgical team on children in a third world country. We hope that our experience will inspire others to perform similar missions throughout the world.
KW - Arterial duct
KW - ligation
KW - third world country
UR - http://www.scopus.com/inward/record.url?scp=78349284056&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=78349284056&partnerID=8YFLogxK
U2 - 10.1017/S1047951109990266
DO - 10.1017/S1047951109990266
M3 - Article
C2 - 20482943
AN - SCOPUS:78349284056
SN - 1047-9511
VL - 20
SP - 367
EP - 372
JO - Cardiology in the Young
JF - Cardiology in the Young
IS - 4
ER -