Esophageal stethoscope in thoracoscopic interruption of patent ductus arteriosus.

There is a significant rate of residual or recurrent ductal patency after video-assisted thoracoscopic closure of patent ductus arteriosus. Between February 2000 and October 2004, this procedure was carried out on 145 consecutive patients in whom heart sounds were monitored intraoperatively with an esophageal stethoscope. Changes in continuous cardiac murmurs were recorded after placing the 1(st) and 2(nd) vascular clips. There was no ductal flow after clipping twice in 138 (95%) patients; in the other 7, residual flow was abolished at the 3(rd) attempt. All patients left the operating room with no residual ductal patency on echocardiography. After 6 months, there was no incidence of residual patency. Intraoperative esophageal stethoscopy provides remarkably loud and clear heart sounds for direct monitoring and reliable evaluation of the entire course of thoracoscopic patent ductus arteriosus closure, without interrupting the surgical procedure, thus avoiding re-intervention and complications associated with residual ductal flow.