Management of patent ductus arteriosus: a comparison of operative v pharmacologic treatment.
Over a 5-year period ending June 1986, 183 premature infants with evidence of a hemodynamically significant patent ductus arteriosus (PDA) associated with cardiopulmonary compromise underwent pharmacologic and/or surgical ductal manipulation. One hundred seven infants underwent surgical ligation and 76 initially received indomethacin. The average birth weight was 10% less and 1 week less for the surgically treated v the indomethacin-treated infants. Among the infants undergoing ligation, there were no failures of therapy and one surgically related complication. Among the infants receiving indomethacin, 42% failed to improve, and 84% of these infants required surgical intervention. Those infants who failed indomethacin therapy in general weighed less, had a shorter gestation and required prolonged ventilatory support. In no instance was death directly attributable to either therapeutic modality. Our data suggest that surgical ligation of hemodynamically significant PDA yields a more predictable result with low morbidity and no mortality. We believe it is the preferred treatment for premature infants less than 800 g.
Department of Surgery, University of California, Davis Medical Center, Sacramento 95817.
S B
SB
Palder
M Z
MZ
Schwartz
K R
KR
Tyson
C C
CC
Marr
D001724:Birth Weight; D004374:Ductus Arteriosus, Patent / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007213:Indomethacin / Q000627:therapeutic use*; D007231:Infant, Newborn; D007234:Infant, Premature; D008026:Ligation; D008297:Male
D007213:Indomethacin