Patent Ductus Arteriosus Before and After Surgery

Bambang Madiyono; Ismet N. Oesman; Sudigdo Sastroasmoro; Sukman Tulus Putra; Eva Jeumpa Soelaiman; Kukuh Basuki Rachmad

doi:10.14238/pi29.3-4.1989.39-51

Bambang Madiyono Department of Child Health, University of Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jakarta,
Ismet N. Oesman Department of Child Health, University of Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jakarta,
Sudigdo Sastroasmoro Department of Child Health, University of Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jakarta,
Sukman Tulus Putra Department of Child Health, University of Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jakarta,
Eva Jeumpa Soelaiman Department of Child Health, University of Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jakarta,
Kukuh Basuki Rachmad Department of Surgery, University of Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jakarta

DOI: https://doi.org/10.14238/pi29.3-4.1989.39-51

Keywords: patent ductus arteriosus; ventricular septal defect; congenital mitral stenosis; congestive heart failure; murmur; hypertrophy

Abstract

Twenty five patients with patent ductus arteriosus, who had undergone surgical closure were studied retrospectively. Girls were more affected than boys; the sex ratio was 4 : I. Associated cardiac lesions were diagnosed in 3 patients, two with ventricular septal defect and one with congenital mitral stenosis. Congestive heart failure was diagnosed in 5 patients before surgery. Typical continuous murmur was heard in most cases (76%), while in the rest only systolic murmur was detected. Electrocardiographic left atrial enlargement, left ventricular hypertrophy and right ventricular hypertrophy were found in 8%, 48% and 40%, respectively.
Cardiomegaly with increased pulmonary vascular markings was found in 60% of cases, while ratio of left atrial to aortic root diameter greater than 1.2 was detected in 60% of patients. The PDA could be directly visualized by echocardiography in 15 cases.
Cardiac catheterization was performed in 17 cases, 47% with hyperkinetic pulmonary hypertension, 41% with high pulmonary flow without pulmonary hypertension and 12% with mild increased pulmonary flow. The pulmonary-systemic flow ratio (Qp/Qs) was more correlated to pulmonary vascular markings rather than to cardio-thoracic ratio. Division of the ductus was the procedure of choice, but in 16% of cases ductal ligation was performed because of technical reasons. Postoperative catch-up in both weight and height was observed more clearly in children operated at earlier age. Ejection systolic murmur was still detected in 2 patients, in whom hyperkinetic pulmonary hypertension existed prior to surgery. No cardiomegaly was found in patients followedup I year or more after surgery. The mortality was nil.

References

1. ANTHONY, C.L.; ARNON, R.G.; FITCH, C. W.: Patent ductus arteriosus; in Pediatric Cardiology; pp 226-243 (Topan, Singapore 1979).
2. BEHRMAN, R.E.; VAUGHAN, V.C.: Patent ductus arteriosus; in Nelson Textbook of Pediatrics; 13th ed., pp 987-989 (Saunders, Philadelphia 1987).
3. CHAN, K.Y.; TAY, J .S.H.; YIP, W.C.; WONG, H.B.: Growth retardation in children wilh congenital heart disease. J. Singapore Paediat. Soc. 29 : 185-193 (1987).
4. GRAHAM, T.D. : When to operate on a child with congenital heart disease . Pediat. Clins N. Am. 31 : 1275- 1291 (1984) .
5. HEYMANN, M.A.: Palent ductus arteriosus; in Adams, F.H.; Emmanouilides, G.C., Moss' Heart Disease in Infants, Children and Adolescents; 3rd ed., pp 157- 171 (Williams and Wilkins, Baltimore 1983).
6. JONES, J.C.: Twenty-five years' experience with the surgery of patent duel us arteriosus. J . thorac. cardiovasc. Surg. SO : 149-165 (1965).
7. MADIYONO, B.; TRISNOHADI, H.B.; AFFANDI, H.B.: His bundle electrocardiogram in children with secundum atrial septal defect and patent ductus arteriosus . Paediatr. lndones. 21 : 1 (1981).
8. McNAMARA, D.G.; LATSON, L.A.: Longterm follow-up of paiients with malformations for which definitive surgical repair has been available for 25 years or more, in Engle, M.A.: Perloff, J ., Congenital Heart Disease After Surgery. Benefit, residual , sequelae; 1st ed., pp 77-99 (Yorke Medical Books, New York 1983).
9. MIKHAIL, M.; LEE, W. ; TOENS, W.: Surgical and medical experience with 734 premature infant with patent ductus arteriosus. J. thorac. cardiovasc. Surg. 83 : 349-354 (1982).
10. NADAS, A.S.; FYLER, D.C.: Patent ductus arteriosus; in Pediatric Cardiology; 2nd ed., pp 405-431 (Saunders, Philadelphia 1972).
11. PERLOFF, J .K.: Patent ductus arteriosus; in The Clinical Recognition of Congenital Heart Disease; 3rd ed., pp 467-497 (Saunders, Philadelphia 1987).
12. RACHMAD, K.B.: Tindakan pembedahan jantung pada penyakit jantung bawaan. Diagnosis and penatalaksanaan penyakit jantung bawaan yang dapat dikoreksi . Naskah Lengkap Pendidikan Tambahan Berkala Ilmu Kesehatan Anak XI, Fakultas Kedokteran Universitas Indonesia, pp 88-96, Jakarta 31 Juli- I Agustus 1985.
13 . ROWE, R.D.: Patent ductus arteriosus; in Keith, J .D.; Rowe, R.D.; Flad, P., heart disease in infant and children; pp 418- 451 (Macmillan, New York 1978).
14. RUDOLPH, A. : The ductus arteriosus; in Anderson, R.H.; Shinebourne, E.A., Paediatric Cardiology 1977 pp 406-416 (Churchill Livingstone, Edinburgh 1978).
15 . SASTROASMORO, S.; MADIYONO, B.; OESMAN, N.l.; AFFANDI, M.: Penatalaksanaan pasca bedah penyakit jantung bawaan. Diagnosis dan penatalaksanaan penyakit jantung bawaan yang dapat dikoreksi. Naskah Lengkap Pendidikan Tambahan Berkala Ilmu Kesehatan Anak XI, Fakultas Kedokteran Universitas Indonesia, pp 97-107, Jakarta 31 Juli â€“ I Agustus 1985.
16. SHINEBOURNE, E.A.; ANDERSON, R.H.: Persistent ductus arteriosus; in Current Paediatric Cardiology; pp 202-205 (Oxford University Press, Oxford 1980).
17. SUONINEN, P.: Physical growth of children with congenital heart disease. Pre- and postoperative study of 355 cases. Acta Paediat. scand. Suppl. 225, pp 16-21 (1971).