Ciro Denevitz de Castro HerdyI; Fued Michel AbílioI; Nelson VieiraI; Sérgio Blanes BrancaglionI; Leonardo Silveira de CastroI; Júlio César Peclat de OliveiraI; Carlos Alberto M PintoI; João B ThomazI; Sérgio L. de AzevedoI
DOI: 10.1590/S0102-76381996000300006
ABSTRACT
The patent ductus arterious frequently occurs in premature neonates causing serious cardiopulmonary disfunction. The treatment includes two options; one clinic and the other surgical procedure. The surgery for patent ductus arteriosus has been done since 1938. Clinical treatment with indometacin induces closure of the arteriosus ductus. The aim of the article is to analize the surgical results with thoractomy by triple-ligature of the ductus for the treatment of persistent ductus arteriosus in fourteen patients including low weight children and premature neonates with cardiopulmonary disfunction. The indications for surgery in these cases were respiratory distress and congestive heart failure. The technique used was triple-ligature of the patent ductus arteriosus. There were no complications neither mortality. The Neonate Intensive Care Unit was important for the evolution of these patients. Our study showed good results achieved by this technique, with low mortality and morbidity and the importance of the Intensive Care Unit for the evolution of these patients.RESUMO
A persistência do canal arterial ocorre com freqüência em neonatos prematuros, provocando um grave quadro de disfunção cardiopulmonar. O tratamento envolve duas abordagens, sendo uma clínica e outra cirúrgica. A operação para a ligadura do canal arterial é praticada desde 1938. O enfoque clínico preconiza o uso da indometacina, com o intuito de promover a oclusão do canal arterial. O presente trabalho tem por objetivo avaliar os resultados obtidos com o tratamento cirúrgico da persistência do canal arterial, através de toracotomia e ligadura em 14 pacientes, incluindo crianças de baixo peso e neonatos prematuros com quadro clínico instável. A principal indicação cirúrgica, nestes casos, foi a presença de insuficiência respiratória aguda e insuficiência cardíaca. A técnica empregada foi a tripla ligadura do canal arterial. Nos 14 casos não obtivemos nenhum tipo de complicação e sem mortalidade. A presença de uma Unidade de Tratamento Intensivo Neonatal (U.T.I) no Hospital foi de extremo valor no preparo dos pacientes e na evolução no período de pós-operatório. Este trabalho comprova a eficácia do método cirúrgico empregado, com baixas taxas de morbidade e mortalidade e a importância da U.T.I neonatal no acompanhamento dos pacientes.REFERENCES
1. Barst R J & Gersony W M - The pharmacological treatment of patent ductus arteriosus. Drugs, 1989; 38: 249-66. [MedLine]
2. Cleveland R J, Nelson R J, Emmanouilides G C - Surgical management of patent ductus arteriosus in infancy. Arch Surg 1969; 99: 516-20. [MedLine]
3. Edmunds Jr. L H - Operation or indomethacin for premature ductus. Ann Thorac Surg 1978; 26: 586-9. [MedLine]
4. Siegal R E - Galen's experience and observation on pulmonary blood flow and respiration. Am J Cardiol 1962; 10: 738-45. [MedLine]
5. Skoda J - Protokolf des sections-sitaung fur Physiologie und Pathologie. Wbi Z Gls Aertze 1855; 1: 720-2.
6. Langer C - Zur anatomis der totalen Kreislauef organe. Z Ges Wien Artze 1857; 13: 328-38.
7. Graybriel A, Strieder J W, Boyer W H - An attempt to obliterate the patent ductus arteriosus in a patient with subacute bacterial endocarditis. Am Heart J 1938; 15: 621-4.
8. Gross R E & Hubbard J P - Surgical ligation of a patent ductus arteriosus: report of first successful case. Jama 1939; 112: 729-31.
9. Edwards D K, Wayne M D, Northway W H - Twelve year's experience with bronchopulmonary dysplasia. Pediatries 1977; 59: 839-46.
10. Friedman W F, Hirschlau M J, Printz M P, Pitlick P L - Pharmacologic closure of ductus arteriosus in premature infants. N Engl J Med 1976; 295: 526-9. [MedLine]
11. Meier M A, Jasbik W, Coutinho J H et al. - Manuseio do canal arterial patente no prematuro com síndrome de angústia respiratória: ligadura ou indometacina? Rev Bras Cir Cardiovasc 1989; 4: 9-20.
12. Cassady G, Crouse D T, Kirklin J W et al. - A randomized controled trial of very early prophylatic ligation of ductus arteriosus in babies who weighed 1000g or less at birth. N Engl J Med 1989; 320: 1511. [MedLine]
13. Macruz R & Snitcowsky R, eds. Cardiologia pediátrica. São Paulo: Sarvier. 1983.
14. Way A L, Pierce Y R, Wolfe R R et al. - ST depression suggesting subendorcadial ischemia in neonates with respiratory distress syndrome and patent ductus arteriosus. J. Pediatr 1979; 95: 609-11. [MedLine]
15. Rudd P, Montanez P, Silverman M - Indomethacin treatment for patent ductus arteriosus in very-low-birth-weight infants: double blind trial. Arch Dis Child 1983; 58: 267-70. [MedLine]
16. Gersony W M, Pecham G J, Ellison R C, Miettinen O S, Nadas A S - Effects of indomethacin in premature infants with patent ductus arteriosus: results of a national collaborative study. J Pediatr 1983; 102: 895-906. [MedLine]
17. Palder S B, Schwartz M Z, Tyson K R T, Marr C C - Management of patent ductus arteriosus: a comparision of operative versus pharmacological treatment. J Pediatr Surg 1987; 22: 1171-4. [MedLine]
18. Sharpe G L - Pharmacology of prostaglandin synthetase inhibitors. In: Proceedings of the 75th Ross Conference on Pediatric Research. Palm Beach: 1977.
19. Caldera R & Badoual J - Vitamine E et fermeture du canal arteriel du prematuré. Arch Fr Pediatr 1981; 38: 817. [MedLine]
20. Heymann E, Ohlsson A, Shennan A T, Heilbut M, Coceani F - Closure of patent ductus arteriosus after treatment with dexamethasone. Acta Pediatr Scand 1990; 79: 698-700.
21. Brandt B, Marvin W J et al. - Ligation of patent ductus arteriosus in premature infants. Ann Thorac Surg 1981; 32: 167-72.
22. Coster D D, Gorton M E, Schneider R F et al. - Surgical closure of patent ductus arteriosus in the neonatal care unit. Ann Thorac Surg 1989; 48: 386-9. [MedLine]
23. Hoffman M, Greve H, Kortman - Operative versehlub des persistierenden ductus arteriosus bei kleinen fruhgeborenen im inkubator. Klin Padiatr 1991; 203: 20-3. [MedLine]