Conversion to thoracotomy of video-assisted thoracoscopic closure of patent ductus arteriosus.

INTRODUCTION: Posterolateral thoracotomy was the access of choice in surgical treatment of patent ductus arteriosus (PDA) for many years before the introduction of video-assisted thoracoscopic surgery (VATS). The latter is thought to reduce postoperative pain and improve musculoskeletal system status. However, it carries a potential risk of conversion to thoracotomy. AIM: To evaluate the rate, reasons and outcomes of VATS conversion to thoracotomy in surgical PDA patients. MATERIAL AND METHODS: From 2012 to 2017, 112 children were qualified for VATS closure of symptomatic PDA. Among them, 19 (16.9%) with the median age of 19.4 months required conversion to thoracotomy. The predominant reasons for conversion, early mortality and morbidity as well as late survival were evaluated. RESULTS: The overall conversion rate was 16.9% with an evident learning curve as it decreased significantly from more than 20% at the beginning to approximately 10% in the last 2 years. The predominant reasons were incomplete PDA closure (n = 6; 31.6%) followed by ductal bleeding after clip application (n = 5; 26.3%) and inadequate visualization (n = 5). One child died 48 h after the surgery due to acute cardiopulmonary failure (mortality 5.9%). All patients required postoperative chest tube insertion, and two of them developed postoperative pneumothorax. Neither deaths nor severe adverse events were noted throughout the follow-up period. CONCLUSIONS: The rate of VATS PDA closure conversion to standard thoracotomy features a learning curve. Although it must be considered as a serious complication, probably it does not negatively affect either early the mortality rate or long-term survival.

Surgical closure of patent ductus arteriosus in extremely low birth weight infants weighing less than 750 grams.

BACKGROUND: Patent ductus arteriosus (PDA) occurs more frequently in premature infants. Depending on the degree of prematurity, these children often have other serious comorbidities that could have a significant impact on surgical outcome. AIM: This study aimed to evaluate the clinical results of surgical ligation of PDA in extremely low body weight preterm infants with birth weight below 750 g, and to identify risk factors of mortality. METHODS: A total of 31 preterm infants with birth weight below 750 g and significant PDA were operated between 2006 and 2016 through posterolateral thoracotomy (n = 16) or with the use of video-assisted thoracoscopic method (n = 15). Mean weight at the time of surgery was 750.8 ± 104.7 g. The gestational age ranged from 22 to 32 weeks. Data were retrospectively analysed, and prospective 100% follow-up was performed. RESULTS: In-hospital mortality was 25.8% (n = 8). The type of surgery had no influence on the results. During the follow-up period lasting 5.2 ± 2.5 years, two other patients died. One-year and five-year probability of survival was 77.4% and 74.2%, respectively. The predominant cause of death was acute heart failure. All patients with preoperative renal dysfunction died in the postoperative period. Moreover, Cox regression analysis revealed renal dysfunction as an independent risk factor of early death. CONCLUSIONS: Preterm infants with birth weight less than 750 g and significant PDA are highly challenging patients. Despite the recent advances in perioperative management with neonates, surgery is still associated with a high early mortality rate irrespective of the applied method.

Minimally invasive thoracoscopic closure versus thoracotomy in children with patent ductus arteriosus.

BACKGROUND: Patent ductus arteriosus (PDA) is one of the most common congenital heart defects. Once diagnosed, an immediate pharmacologic or invasive treatment should be performed. The purpose of this work was to evaluate the safety and efficacy of surgical PDA ligation in children using video-assisted thoracoscopic surgery (VATS) in comparison with a conventional muscle-sparing posterolateral thoracotomy technique (MSPLT). MATERIALS AND METHODS: In this single-center, retrospective study 173 children qualified for surgical PDA closure were enrolled. Patients were divided according to their weight and type of surgery performed. The groups consisted of patients operated through thoracotomy (54%) or VATS (46%). Operative characteristics, cosmetic effect, postoperative complications and long-term survival were evaluated. RESULTS: Regardless of weight, fewer complications were noted in children after thoracoscopic clipping. Fifteen VATS patients required intraoperative conversion to thoracotomy; however, adverse sequelae were not observed. Aesthetics seemed to be the major complaint after conventional surgery. We did not observe any statistically significant differences in the long-term survival between both groups. CONCLUSIONS: Both techniques were shown to be safe and effective. Unsuccessfully performed thoracoscopic surgeries were safely converted to conventional thoracotomy. VATS, being a less invasive approach, leads to a better aesthetic effect and lower surgical complication rate.

Wilms' Tumor With Intra-Atrial Extension: Treatment and Management.

Wilms' tumor is the most common renal cancer in children. It can grow for a long time without any characteristic symptoms, causing only fever, abdominal pain, nausea, or vomiting, which is the reason why it is often discovered accidentally. In 1% to 4% of the cases, nephroblastoma leads to complications in the form of intravascular and intra-atrial extension. We present a case of a five-year-old boy with Wilms' tumor extending into the inferior vena cava, right atrium, and then prolapsing through the tricuspid valve into the right ventricle.

Mechanical circulatory support after surgical repair of Bland-White-Garland syndrome. A study of three cases.

The anomalous origin of the left coronary artery arising from the pulmonary artery (ALCAPA), also known as Bland-White-Garland (BWG) syndrome, is a rare congenital heart disease. We present cases of three children in whom BWG syndrome was repaired surgically. In two of them, the left coronary artery was transplanted from the pulmonary trunk to the aorta, and in one, the Takeuchi procedure was performed. In both cases in which the left coronary artery was transplanted to the aorta, mechanical circulatory support was used after the surgery. This was due to a low ejection fraction (10%) while weaning from cardiopulmonary bypass. Although associated with numerous complications, mechanical circulatory support can be a lifesaving therapy in patients with a poor left ventricular function after the correction of BWG syndrome.

[Unstable angina with subvalvular aortic stenosis in a 65-year-old woman]. / Niestabilna dlawica piersiowa u chorej ze wspólistniejacym podzastawkowym zwezeniem aorty.

We describe a case of 65-year-old woman with unstable angina, who was admitted to our institution. Physical examination revealed the presence of a systolic cardiac murmur. Transthoracic echocardiography showed subvalvular aortic stenosis. The patient underwent successful coronary artery by-pass surgery and myectomy surgery. Diagnosis and treatment of subvalvular stenosis coexistent with coronary artery disease are discussed.