SURGICAL TREATMENT OF THE PATENT DUCTUS ARTERIOSUS IN ADULTS: ABOUT FIVE CASES.

M.j. Rhissassi, H.Wazaren, H.Bouhdadi, M.M. Maharazou, A.Aghzar, i.benabderrazak, N.El Moktadir, I.Maaroufi , C.Benlafqih, R.Sayah and M.Laaroussi. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History Received: 06 February 2019 Final Accepted: 08 March 2019 Published: April 2019 Copy Right, IJAR, 2019,. All rights reserved.


Patients and Methods:-
This is a retrospective study that includes five adult patients operated for ductus arteriosus persistent between February 2015 and June 2016 in the Department of Cardiovascular Surgery A of the Ibn Sina Hospital in Rabat. The inclusion criteria were age over 15 years. Symptoms were dyspnea, failure to thrive, or signs of heart failure. All patients underwent surgery and the surgical technique was a ligation section of the ductus arteriosus by posterolateral thoracotomy.
All patients underwent clinical and echocardiographic investigations before the cure, peri-operatively and at one month of follow-up.

Results:-
Between February 2015 and June 2016, five patients were admitted for surgical treatment of persistent arterial duct. The middle age was 19 years. The male sex was predominant with 4 men and one woman. All patients were symptomatic with exertional dyspnea. 3 patients had cyanosis and failure to thrive was observed in 4 patients (3 men and 1 woman). A continuous murmur in the left intraventricular area was perceived in three patients.
Transthoracic échocardiography was performed in all patients. It revealed the presence of the persistence of ductus arteriosus in all patients. The diameter varied between 7mm and 25mm. The left-to-right shunt was present with pulmonary hypertension ranging between 55mmHg and 75mmHg. Right cardiac chambers were unexplained in all patients. There was enlargement of left ventricle in 4 patients.
Patients were reviewed for clinical and echocardiographic control at one month. The same outcomes were noted.

Discussion:-
The patent ductus arteriosus is a form of congenital heart disease, defined as a persistence of duct beyond the third month of life in infants [1]. It may be associated with other cardiac abnormalities. In adults, it is often isolated [2].
The treatment may be medical, surgical or interventional [3]. Before the emergence of interventional techniques, surgery was the treatment of choice [5]. The technique consists of a section-ligation of the arterial duct through left posterolateral thoracotomy. Thorascopic procedures are probably not appropriate for the adult because of frequency of calcification and the greater the risk of rupture while ligating the ductus [6].
In patients over 40 years of age, or in the presence of severe ductus calcification or aneuvrysm, considiration should be given to performing PDA ligation via a median sternotomy using cardiopulmonary bypass [7].
In children, the outcomes of surgery are associated with lower morbidity and shorter hospital stays [9]. In adults, in presence of a large diameter, an aneurysm, an endarteritis or an abscess of the duct, surgery is indicated. The majority of series reports that the surgery confers a complete closure of the canal in 94-100% of cases, with a mortalityrate of 0-2%. The endovascular treatment is technically more difficult in adults than in children, so that the surgery is more indicated in adults where it's more safe and effective, confering complete results [9].