Surgery of Patent Ductus Arteriosus in Soavinandriana Hospital: Our Experience

Abstract

Introduction: The missionaries of Doctors of the World began performing the surgical closures of patent ductus arteriosus in Madagascar in 2004. The Malagasy team has been completely autonomous in surgical closures of an isolated patent ductus arteriosus since 2018. The aim of this study was to report on the Malagasy team's experience in the first 5 years of surgical closure of an isolated patent ductus arteriosus at Soavinandriana Hospital. Methods: This was a retrospective and descriptive study, during the five-year period, from January 2018 to December 2022, performed at the Cardiac surgery unit of Soavinandriana Teaching Hospital, including all children underwent surgical closures of an isolated PDA. Demographic data, birth weight, clinical signs, diagnostic imaging, diameter of the ductus, the surgical waiting time after diagnosis, and hospital left stays were analyzed. Results: A total of 104 children underwent surgery of closures of PDA, including 36 boys (34.62%) and 68 girls (65.38%), giving a sex ratio of 52%. The average age was 29.75 months. Fifteen children were born with low birth weight (14.42%). PDA was symptomatic in 84.65% of patients. The commonest symptoms were recurrent pulmonary infections (51.92%) and failure to thrive (25.96%). The mean age at diagnosis was 18 months. Echocardiography showed pulmonary hypertension in 73.25% of cases. The ductus was large in 97.67% of cases, with a mean diameter of 5.17 mm. Chest X-rays showed cardiomegaly (75%) and increased pulmonary vascularization (39.42%). The mean time to surgery after diagnosis was 7.28 months. All patients underwent left posterolateral thoracotomy with sectioning and suturing of the ductus arteriosus. The average hospital stay was 7.33 days. Conclusion: PDA was the most common symptomatic (83.65%) and large (90.38%). Surgical closures of PDA were satisfied in our practice.