Date of Procedure: Scheduled Time: Case/Log ID: Patient: MRN: DOB: Pre-Operative Diagnosis: Patent ductus arteriosus, prematurity, respiratory/congestive heart failure. Post-Operative Diagnosis: Patent ductus arteriosus, prematurity, respiratory/congestive heart failure. Procedures: Left thoracotomy and ligation of patent ductus arteriosus Surgeon: Assistants: Anesthesia Type: General Anesthesia Staff: Anesthesiologist : Anesthesiologist 2: Estimated Blood Loss: Minimal Procedural Findings: Large patent ductus arteriosus Referring Cardiologist: Brief Preoperative History: Patient is a 6 week old, 1.0 kg female born at 23 weeks with a large patent ductus arteriosus and respiratory/congestive heart failure. Ligation is indicated for relief of congestive heart failure and to improve his/her respiratory status. I have met with the family and explained the planned procedure, indications and risks. The family is well informed and wishes for us to proceed. Description of Procedure: The patient was identified in the Neonatal Intensive Care Unit and her bedspace was isolated as an operating room area. General endotracheal anesthesia was induced by the anesthesiologist and an adequate level maintained throughout surgery. Adequate intravenous access was obtained. Monitoring placed. The patient was placed in the right lateral decubitus position. The left chest prepped draped and in the usual sterile manner. Safety time out performed. A left posterior lateral thoracotomy was performed and the chest entered through the 4th interspace. The pleura overlying the distal arch and proximal descending aorta was incised. A pleural flap created and reflected medially. The ductus arteriosus identified. It was large. The recurrent nerve was identified and protected from injury. The ductus arteriosus was dissected out and ligated with a medium hemoclip. There was no bleeding. The systemic pressure rose as anticipated. Intercostal nerve blocks were placed with 1/4% Marcaine with epinephrine. The left chest was drained with a 10 Fr. Blake drain and the incision closed in layers. A dry sterile dressing applied. Debriefing completed. The patient tolerated the procedure well.
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