title: Primary surgical closure should be considered in premature neonates with large patent ductus arteriosus.
abstract: BACKGROUND
  Treatment for patent ductus arteriosus (PDA) in premature infants can consist of medical or surgical approaches. The appropriate therapeutic regimen remains contentious. This study evaluated the role of surgery in improving the survival of premature neonates weighing less than 1,500 g with PDA.
  
  
  METHODS
  From January 2008 to June 2011, 68 patients weighing less than 1,500 g with PDA were enrolled. The patients were divided into three groups: a group managed only by medical treatment (group I), a group requiring surgery after medical treatment (group II), and a group requiring primary surgical treatment (group III).
  
  
  RESULTS
  The rate of conversion to surgical methods due to failed medical treatment was 67.6% (25/37) in the patients with large PDA (≥2 mm in diameter). The number of patients who could be managed with medical treatment was nine which was only 20.5% (9/44) of the patients with large PDA. There was no surgery-related mortality. Group III displayed a statistically significantly low rate of development of bronchopulmonary dysplasia (BPD) (p=0.008). The mechanical ventilation time was significantly longer in group II (p=0.002).
  
  
  CONCLUSIONS
  Medical treatment has a high failure rate in infants weighing less than 1,500 g with PDA exceeding 2.0 mm. Surgical closure following medical treatment requires a longer mechanical ventilation time and increases the incidence of BPD. Primary surgical closure of PDA exceeding 2.0 mm in the infants weighing less than 1,500 g should be considered to reduce mortality and long-term morbidity events including BPD.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Inje University Busan Paik Hospital, Inje University College of Medicine, Korea.
authors.forename: Seong-Min
authors.initials: SM
authors.lastname: Ko
authors.forename: Young Chul
authors.initials: YC
authors.lastname: Yoon
authors.forename: Kwang-Hyun
authors.initials: KH
authors.lastname: Cho
authors.forename: Yang-Haeng
authors.initials: YH
authors.lastname: Lee
authors.forename: Il-Yong
authors.initials: IY
authors.lastname: Han
authors.forename: Kyung-Taek
authors.initials: KT
authors.lastname: Park
authors.forename: Yoon Ho
authors.initials: YH
authors.lastname: Hwang
authors.forename: Hee Jae
authors.initials: HJ
authors.lastname: Jun
keywords: Neonate; Patent ductus arteriosus; Premature