A review of 936 operations (1946-69)
Nine hundred and thirty-six consecutive cases of closure of a patent ductus arteriosus in infants and children are reported. Among 789 without any other cardiac anomalies there were 11 deaths, seven of these with severe congenital anomalies other than cardiovascular. There was one incomplete closure. The deaths in this series were mostly associated with additional congenital cardiac anomalies. Forty-eight of the 59 who died had additional cardiac anomalies. Forty-seven of the deaths were in infants. For 691 patients over the age of 1 year the hospital mortality rate was less than 0·5%.
Ligation of the ductus using two ligatures of thick plaited silk (1·2 mm diameter) was the technique used in 99% of these cases. There were four cases of recanalization or inadequate ligation but all four survived. This technique seems an acceptable one for the closure of a patent ductus arteriosus.
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↵2 Present address: The Children's Hospital of Philadelphia, 18th and Bainbridge Streets, Philadelphia, Pennsylvania 19146, U.S.A.
↵3 Reprint requests to: D. J. Waterston, M.B.E., F.R.C.S., The Hospital for Sick Children, Great Ormond Street, London WC1N 3JH.
↵1 The word `ductus' is used here with the definition given by most dictionaries to mean a tube, canal or passage with well-defined walls. We support the definition given by Dorland's Medical Dictionary (1965) which distinguishes a ductus arteriosus (the presence of the vessel) from a patent ductus arteriosus (the vessel with a persistently open lumen). Any ductus is persistent if it was present in the fetus, but it will allow the passage of blood only if it is patent. `Patent ductus arteriosus' is, therefore, a correctly descriptive term and should be preferred to `persistent ductus arteriosus' or `ductus arteriosus'.
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