The adult ductus: review of surgical experience with 131 patients.

Results in patients over 14 years of age who have undergone surgical closure of a patent ductus arteriosus during the period 1967 through 1979 have been reviewed. There were 131 subjects (average age 22 years) with a slight male predominance, which is at variance with other reports. Sixty-two subjects underwent hemodynamic evaluation and of these, 30 had pulmonary artery pressures ranging from 50 to 150 mm Hg. Division and suture of the ductus with aortic cross-clamping under normothermic conditions was performed in 61 subjects. This approach was particularly indicated in cases in which the ductus was unusually short in relation to its diameter as well as in many with atheromatous changes at the aortic end. In 65 subjects, the conventional division and suture with ductus clamps was employed. Total cardiopulmonary bypass with transaortic patch closure of the ductus was carried out in three instances. There were five early deaths which were principally associated with severe pulmonary hypertension. During a follow-up period extending from 1 to 11 years, three subjects died, but the remainder are well and active. Recatheterization data in nine patients with severe pulmonary hypertension showed gratifying results.