Controlled Hypotension in the Surgical Treatment of Certain Cases of Patent Ductus Arteriosus

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THE surgical treatment of patent ductus arteriosus is well established and is indicated in almost every case. Usually it is not technically difficult, particularly in children. However there are certain cases, mostly in adults, in which the operative procedure is fraught with technical difficulty and hazard. These cases are complicated by degenerative vascular disease or unusual anatomic configuration of the ductus and adjoining vessels. The vessel walls about the ductus may have undergone changes caused either by cystic medial necrosis or by subacute endarteritis; calcium deposits may have formed beneath the intima. Large ducti may be associated with hypertension and secondary aneurysmal changes in the pulmonary artery. Occasionally a ductus may be of large caliber and short length, resembling an aortic pulmonary window more than a persistent vessel that communicates between the aorta and pulmonary artery. Whenever one or more of these features are present, the ductus is no longer a pliable plastic vessel that is amenable to safe surgical closure. Furthermore, the danger of uncontrolled hemorrhage increases directly with the degrees of vascular degeneration and pulmonary hypertension.

Controlled hypotension during surgery is an established technic that has proved of considerable value in conditions where frank hemorrhage or troublesome oozing is anticipated.1–3 It has been most widely used by neurosurgeons and those surgeons doing extensive abdominal operations for advanced carcinoma. It not only reduces hemorrhage but shortens operative time. However, it certainly is a procedure not to be undertaken lightly and has definite contraindications including severe anemia, disease of . . .



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