A 7-month-old girl was found to have patent ductus arteriosus(PDA) and poor aortic development immediately after birth. After conservative treatment with medications, the PDA was not closed. The child had growth retardation and repeated upper respiratory tract infections. Later, she went to our hospital for treatment. Undergoing cardiac color Doppler ultrasound and cardiac CT three-dimensional imaging, it was found that the child's PDA was not closed and the ascending aorta was narrowed. Considering that the current disease has affected the child’s growth and development, surgery was taken after discussion. Physical examination on admission: heart rate 128 beats/min, breathing 28 beats/min, left upper limb blood pressure 93/52mmHg, left lower limb 110/90mmHg, right upper limb 106/51mmHg, right lower limb 125/79mmHg, auscultation at the second rib of the left sternum Intermittent murmurs could be heard. On admission, CT and color Doppler ultrasound showed that there was a 6mm tube under the aortic arch connected to the main pulmonary artery and the ascending aorta had a transverse diameter of about 6mm (Figure 1).
In order to deal with PDA, and considering that the child was only 7 months old and weighs only 7kg, we adopted the Da Vinci robot-assisted patent ductus arteriosus ligation. Take the supine position with the head low and the feet high. The 6th intercostal hole in the mid-axillary line was used to place the camera, and the fourth intercostal hole in the anterior axillary line and the seventh intercostal hole in the posterior axillary line were used for operation. At the same time, a hole was placed in the fifth intercostal space of the anterior axillary line for the assistant to assist in retracting the lung tissue and exposing the descending aorta. The surgeon operated on the main console and cut the descending aortic sheath longitudinally (up to the beginning of the left subclavian artery, down to 2-4 cm below the lower edge of the arterial duct), and free the right marginal space of the descending. Free the arterial catheter and ligated the arterial catheter twice with silk thread(Figure 2). The total operation time was 80 minutes, of which the robot operation time was 50 minutes, the blood loss during the operation was less than 2ml, and no surrounding tissues were damaged. The child had no surgery-related complications after the operation. Postoperative re-examination of cardiac color Doppler ultrasound revealed no residual shunt,and the ascending aorta had a transverse diameter of 7.9mm.