# Patent Ductus Arteriosus — GCMD Library living collection

Everything in the library about patent ductus arteriosus — built automatically from dossiers that name it.

Updated: n/a · 3 episodes · 23 cited statements

## Episodes
### Surgical Management
- [PDA ligation narrated](https://team.globalcastmd.com/watch/pda-ligation-narrated-11950) — video · 6:24 · [machine version](https://team.globalcastmd.com/watch/pda-ligation-narrated-11950.md)

### Evidence & Research
- [Expectant Management or Early Ibuprofen for Patent Ductus Arteriosus](https://team.globalcastmd.com/watch/expectant-management-or-early-ibuprofen-for-patent-ductus-arteriosus-7075) — video · 1:14 · [machine version](https://team.globalcastmd.com/watch/expectant-management-or-early-ibuprofen-for-patent-ductus-arteriosus-7075.md)
- [Manejo expectante o ibuprofeno temprano para el tratamiento del conducto arterioso persistente](https://team.globalcastmd.com/watch/manejo-expectante-o-ibuprofeno-temprano-para-el-tratamiento-del-conducto-arterioso-persistente-7076) — video · [machine version](https://team.globalcastmd.com/watch/manejo-expectante-o-ibuprofeno-temprano-para-el-tratamiento-del-conducto-arterioso-persistente-7076.md)

## Chapters
- [0:00](https://team.globalcastmd.com/watch/expectant-management-or-early-ibuprofen-for-patent-ductus-arteriosus-7075?t=0) Non-inferiority trial of expectant management versus early ibuprofen for PDA in preterm infants (Ep 1)
- [0:00](https://team.globalcastmd.com/watch/manejo-expectante-o-ibuprofeno-temprano-para-el-tratamiento-del-conducto-arterioso-persistente-7076?t=0) Non-inferiority trial of expectant management versus ibuprofen for patent ductus arteriosus in extremely premature infants (Ep 2)
- [0:02](https://team.globalcastmd.com/watch/pda-ligation-narrated-11950?t=2) Patient positioning, port placement, and initial dissection (Ep 3)
- [3:00](https://team.globalcastmd.com/watch/pda-ligation-narrated-11950?t=180) Dissection and mobilization of the ductus arteriosus (Ep 3)
- [5:00](https://team.globalcastmd.com/watch/pda-ligation-narrated-11950?t=300) Clip application and occlusion of the PDA (Ep 3)
- [6:00](https://team.globalcastmd.com/watch/pda-ligation-narrated-11950?t=360) Lung biopsy and closure (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- The infant undergoing thoracoscopic PDA ligation weighs 2 kg. (clinical) [Ep 3 · 0:02](https://team.globalcastmd.com/watch/pda-ligation-narrated-11950?t=2)
- The patient is placed in a modified prone position with the left side elevated approximately 30 degrees for thoracoscopic PDA ligation. (clinical) [Ep 3 · 0:20](https://team.globalcastmd.com/watch/pda-ligation-narrated-11950?t=20)
- Port placement includes a 4 mm scope slightly behind and above the scapula tip, and 3 mm and 5 mm working ports. (clinical) [Ep 3 · 0:50](https://team.globalcastmd.com/watch/pda-ligation-narrated-11950?t=50)
- Simple insufflation is used to collapse the lung; single lung ventilation is not required, although it can be used in larger patients. (clinical) [Ep 3 · 1:20](https://team.globalcastmd.com/watch/pda-ligation-narrated-11950?t=80)
- A 3 mm port is initially placed in the posterior axillary line in approximately the fifth intercostal space to aid dissection, later changed to a 5 mm port for clip placement. (clinical) [Ep 3 · 1:50](https://team.globalcastmd.com/watch/pda-ligation-narrated-11950?t=110)
- It is important not to use monopolar cautery near the ductus because of the risk of injuring the recurrent laryngeal nerve. (clinical) [Ep 3 · 2:30](https://team.globalcastmd.com/watch/pda-ligation-narrated-11950?t=150)
- Creating a pleural flap over the mid portion of the aorta helps safely retract the vagus and recurrent laryngeal nerves out of the way. (clinical) [Ep 3 · 3:10](https://team.globalcastmd.com/watch/pda-ligation-narrated-11950?t=190)
- In this case, the ductus is large, approximately two-thirds the diameter of the aorta. (clinical) [Ep 3 · 3:50](https://team.globalcastmd.com/watch/pda-ligation-narrated-11950?t=230)
- Careful blunt dissection is used to dissect behind the ductus to avoid injuring the recurrent laryngeal nerve or tearing the ductus. (clinical) [Ep 3 · 4:10](https://team.globalcastmd.com/watch/pda-ligation-narrated-11950?t=250)
- Gentle spreading with the 3 mm vessel sealer is an excellent way to achieve adequate mobilization of the ductus. (opinion) [Ep 3 · 4:30](https://team.globalcastmd.com/watch/pda-ligation-narrated-11950?t=270)
- It is generally recommended to spread in the direction of the ductus to eliminate the risk of tearing it. (clinical) [Ep 3 · 4:55](https://team.globalcastmd.com/watch/pda-ligation-narrated-11950?t=295)
- Test clamping of the ductus is performed with a distal pulse oximeter on the foot to ensure the correct structure is being occluded. (clinical) [Ep 3 · 5:20](https://team.globalcastmd.com/watch/pda-ligation-narrated-11950?t=320)
- It is very important to have proximal and distal monitoring during PDA ligation. (clinical) [Ep 3 · 5:40](https://team.globalcastmd.com/watch/pda-ligation-narrated-11950?t=340)
- A single 5 mm endoclip is placed on the ductus after the 3 mm trocar is changed to a 5 mm trocar. (clinical) [Ep 3 · 5:50](https://team.globalcastmd.com/watch/pda-ligation-narrated-11950?t=350)
- It is important to deploy the clip into the clip applier before placing it onto the duct, as deploying while already around the duct can force the tissue away. (clinical) [Ep 3 · 6:05](https://team.globalcastmd.com/watch/pda-ligation-narrated-11950?t=365)
- The clip application resulted in complete occlusion of the ductus. (clinical) [Ep 3 · 6:20](https://team.globalcastmd.com/watch/pda-ligation-narrated-11950?t=380)
- The patient had evidence of interstitial lung disease on CT scan, and the pulmonologist requested a lung biopsy for better evaluation. (clinical) [Ep 3 · 6:30](https://team.globalcastmd.com/watch/pda-ligation-narrated-11950?t=390)
- A 5 mm stapler is appropriate in size for a 2 kg infant for performing a wedge lung biopsy. (clinical) [Ep 3 · 7:00](https://team.globalcastmd.com/watch/pda-ligation-narrated-11950?t=420)
- Care must be taken to ensure tissue is far enough into the stapler so the staple line reaches across the entire line of the resected specimen. (clinical) [Ep 3 · 7:20](https://team.globalcastmd.com/watch/pda-ligation-narrated-11950?t=440)
- A single firing of the stapler is all that is needed for the wedge biopsy. (clinical) [Ep 3 · 7:40](https://team.globalcastmd.com/watch/pda-ligation-narrated-11950?t=460)
- The lung biopsy specimen is removed through the 5 mm port site without difficulty. (clinical) [Ep 3 · 7:50](https://team.globalcastmd.com/watch/pda-ligation-narrated-11950?t=470)
- No chest drain was left because there was no air leak at the end of the procedure. (clinical) [Ep 3 · 6:24](https://team.globalcastmd.com/watch/pda-ligation-narrated-11950?t=384)
- All incisions were closed in layers with absorbable suture. (clinical) [Ep 3 · 6:24](https://team.globalcastmd.com/watch/pda-ligation-narrated-11950?t=384)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- A multi-center non-inferiority trial compared preterm infants treated with expectant management versus early ibuprofen for PDA — Cecilia Gigena summarizing a resource [Ep 1 · 0:09](https://team.globalcastmd.com/watch/expectant-management-or-early-ibuprofen-for-patent-ductus-arteriosus-7075?t=9)
- The trial enrolled 273 infants total — Cecilia Gigena summarizing a resource [Ep 1 · 0:22](https://team.globalcastmd.com/watch/expectant-management-or-early-ibuprofen-for-patent-ductus-arteriosus-7075?t=22)
- 136 infants were treated with expectant management and 137 with early ibuprofen — Cecilia Gigena summarizing a resource [Ep 1 · 0:25](https://team.globalcastmd.com/watch/expectant-management-or-early-ibuprofen-for-patent-ductus-arteriosus-7075?t=25)
- In the expectant management group, 17.6% developed necrotizing enterocolitis — Cecilia Gigena summarizing a resource [Ep 1 · 0:31](https://team.globalcastmd.com/watch/expectant-management-or-early-ibuprofen-for-patent-ductus-arteriosus-7075?t=31)
- In the expectant management group, 33% developed bronchopulmonary dysplasia — Cecilia Gigena summarizing a resource [Ep 1 · 0:31](https://team.globalcastmd.com/watch/expectant-management-or-early-ibuprofen-for-patent-ductus-arteriosus-7075?t=31)
- In the expectant management group, the death rate was 14% — Cecilia Gigena summarizing a resource [Ep 1 · 0:31](https://team.globalcastmd.com/watch/expectant-management-or-early-ibuprofen-for-patent-ductus-arteriosus-7075?t=31)
- In the ibuprofen group, 15.4% developed necrotizing enterocolitis — Cecilia Gigena summarizing a resource [Ep 1 · 0:43](https://team.globalcastmd.com/watch/expectant-management-or-early-ibuprofen-for-patent-ductus-arteriosus-7075?t=43)
- In the ibuprofen group, 50% developed bronchopulmonary dysplasia — Cecilia Gigena summarizing a resource [Ep 1 · 0:43](https://team.globalcastmd.com/watch/expectant-management-or-early-ibuprofen-for-patent-ductus-arteriosus-7075?t=43)
- In the ibuprofen group, the death rate was 80% — Cecilia Gigena summarizing a resource [Ep 1 · 0:43](https://team.globalcastmd.com/watch/expectant-management-or-early-ibuprofen-for-patent-ductus-arteriosus-7075?t=43)
- Expectant management is non-inferior to early ibuprofen in preterm patients with PDA — Cecilia Gigena summarizing a resource [Ep 1 · 1:01](https://team.globalcastmd.com/watch/expectant-management-or-early-ibuprofen-for-patent-ductus-arteriosus-7075?t=61)
- This is a multicenter non-inferiority study comparing extremely premature patients with persistent ductus arteriosus who received expectant management versus ibuprofen treatment. — Cecilia Gigena summarizing a resource [Ep 2 · 0:00](https://team.globalcastmd.com/watch/manejo-expectante-o-ibuprofeno-temprano-para-el-tratamiento-del-conducto-arterioso-persistente-7076?t=0)
- The study enrolled 273 patients: 136 with expectant management and 137 with ibuprofen treatment. — Cecilia Gigena summarizing a resource [Ep 2 · 1:00](https://team.globalcastmd.com/watch/manejo-expectante-o-ibuprofeno-temprano-para-el-tratamiento-del-conducto-arterioso-persistente-7076?t=60)
- Patients receiving expectant management had 17.6% necrotizing enterocolitis, 33.3% bronchopulmonary dysplasia, and 14% mortality. — Cecilia Gigena summarizing a resource [Ep 2 · 1:20](https://team.globalcastmd.com/watch/manejo-expectante-o-ibuprofeno-temprano-para-el-tratamiento-del-conducto-arterioso-persistente-7076?t=80)
- Patients receiving ibuprofen treatment had 15.4% necrotizing enterocolitis, 50.9% bronchopulmonary dysplasia, and 18.6% mortality. — Cecilia Gigena summarizing a resource [Ep 2 · 1:50](https://team.globalcastmd.com/watch/manejo-expectante-o-ibuprofeno-temprano-para-el-tratamiento-del-conducto-arterioso-persistente-7076?t=110)
- Expectant management appears to be non-inferior to ibuprofen treatment in extremely premature patients with persistent ductus arteriosus. — Cecilia Gigena summarizing a resource [Ep 2 · 2:20](https://team.globalcastmd.com/watch/manejo-expectante-o-ibuprofeno-temprano-para-el-tratamiento-del-conducto-arterioso-persistente-7076?t=140)

## Changelog
- Sep 25: 3 items added automatically

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