ABSTRACT
The ductus arteriosus of many preterm infants remains patent at birth. A patent ductus arteriosus (PDA) results in increased blood flow to the lungs, exposing them to systemic blood pressures. The treatment of choice for non-surgical closure of a PDA in most neonatal intensive care units has historically been indomethacin. Thoracoscopic PDA ligation is an alternative to open thoracotomy. It offers the theoretical advantages of better chest wall compliance, decreased risk of scoliosis, and cosmetic improvement. For thoracoscopic PDA ligation, patients are placed in a modified right lateral decubitus position with the left side elevated approximately 30 degrees. Improvement in cardiopulmonary function starts immediately, depending on the volume of flow through the left-to-right shunt and the preoperative status of the heart and lungs. Video-assisted thoracoscopic PDA ligation has been shown to be feasible. Large series of patients undergoing this technique report similar outcomes with the standard advantages of thoracoscopy over thoracotomy being noted.
