Surgical closure of PDA in low-weight premature infants

Abstract

Low-weight premature neonates (LWPNs) frequently have haemodynamically significant patent ductus arteriosus (PDA) responsible for serious complications. Cyclooxygenase inhibitors are used for ductal closure. If the medical treatment fails, the PDA can be legated surgically. We present our experience, since 2006, on PDA surgical closure.

Material and methods. From 2006 to 2009, of the 518 LWPNs, PDA was present in 109 (21%) infants. The mean gestational age was 29.1 weeks. All patients underwent a medical treatment for PDA closure. Because of the failure of medical treatment, 19 patients (17%) underwent surgical closure. The shift from medical to surgical treatment was related to clinical condition and the echocardiographic appearance of PDA. At operation, the mean age was 17 days (9–42 days). The operation was performed through a left lateral thoracotomy in third intercostal space. PDA was clipped with metallic haemoclipps.

Results. No LWPN died as a result of operation (0% early mortality). Post-operative period required inotrophic and diuretic infusion and a more aggressive ventilatory management.

Discussion. In LWPNs, surgical PDA closure is usually given when medical treatment fails. The shift from medical to surgical closure should be based on clinical conditions being surgical PDA closure in the neonatal intensive care unit safe and effective also in extremely LWPNs.

Keywords:

• Cardiac
• surgery
• patent ductus arteriosus
• newborn
• outcome