Successful surgical closure of an arterial duct in 18 children in a third world country

Paul Grossfeld, Mark Greenberg, Sandra Saw, Gloria Cheng, Anthony Stanzi, James Mathewson, Ngeth Pises, Luy Lyda, Sar Vuthy, William Elias, Stephanie Moriarty, Sharon Levy, Deborah Walter, Phillip Panzarella, Susan Grossfeld, Jolene Kriett, Michael Madani

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)367-372
Number of pages6
JournalCardiology in the Young
Volume20
Issue number4
DOIs
StatePublished - Aug 2010

Fingerprint

Developing Countries
Catheters
Cambodia
Patient Care Team
Premature Mortality
Life Expectancy
Ambulatory Surgical Procedures
Palliative Care
Surgical Instruments
Sutures
Heart Diseases
Heart Failure
History
Quality of Life
Pediatrics
Equipment and Supplies
Lung

Keywords

  • Arterial duct
  • ligation
  • third world country

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pediatrics, Perinatology, and Child Health

Cite this

Grossfeld, P., Greenberg, M., Saw, S., Cheng, G., Stanzi, A., Mathewson, J., ... Madani, M. (2010). Successful surgical closure of an arterial duct in 18 children in a third world country. Cardiology in the Young, 20(4), 367-372. https://doi.org/10.1017/S1047951109990266

Successful surgical closure of an arterial duct in 18 children in a third world country. / Grossfeld, Paul; Greenberg, Mark; Saw, Sandra; Cheng, Gloria; Stanzi, Anthony; Mathewson, James; Pises, Ngeth; Lyda, Luy; Vuthy, Sar; Elias, William; Moriarty, Stephanie; Levy, Sharon; Walter, Deborah; Panzarella, Phillip; Grossfeld, Susan; Kriett, Jolene; Madani, Michael.

In: Cardiology in the Young, Vol. 20, No. 4, 08.2010, p. 367-372.

Research output: Contribution to journalArticle

Grossfeld, P, Greenberg, M, Saw, S, Cheng, G, Stanzi, A, Mathewson, J, Pises, N, Lyda, L, Vuthy, S, Elias, W, Moriarty, S, Levy, S, Walter, D, Panzarella, P, Grossfeld, S, Kriett, J & Madani, M 2010, 'Successful surgical closure of an arterial duct in 18 children in a third world country', Cardiology in the Young, vol. 20, no. 4, pp. 367-372. https://doi.org/10.1017/S1047951109990266
Grossfeld, Paul ; Greenberg, Mark ; Saw, Sandra ; Cheng, Gloria ; Stanzi, Anthony ; Mathewson, James ; Pises, Ngeth ; Lyda, Luy ; Vuthy, Sar ; Elias, William ; Moriarty, Stephanie ; Levy, Sharon ; Walter, Deborah ; Panzarella, Phillip ; Grossfeld, Susan ; Kriett, Jolene ; Madani, Michael. / Successful surgical closure of an arterial duct in 18 children in a third world country. In: Cardiology in the Young. 2010 ; Vol. 20, No. 4. pp. 367-372.
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abstract = "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.",
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