SURGICAL AND MEDICAL EXPERIENCE WITH 734 PREMATURE-INFANTS WITH PATENT DUCTUS-ARTERIOSUS

During the past 5 yr, patent arteriosus (PDA) presented in 734 preterm infants (< 2.5 kg and 37 wk gestation) of 2532 admissions (29%). The ductus presented with murmur, bounding pulses and often congestive heart failure. Medical treatment consisted of the following: fluid restriction, furosemide, respiratory support and rarely digoxin. The patients who were unresponsive to medical treatment had surgical ligation (306 of 734 or 42%). The patients who had ductal ligation were smaller, i.e., 82% of the surgical patients weighed < 1.5 kg compared to 38% of the medical patients. Of patients weighing < 1.5 kg, the surgical and medical groups were compared and the following observations made: the incidence of respiratory distress syndrome was greater in the surgical group (86% or 216 of 252 patients vs. 69% or 111 of 161 medical patients, P < 0.001) and the long-term survival was better (89% or 224 of 252 surgical patients vs. 77% or 124 of 161 medical patients, P < 0.005). The average duration of intubation was shorter in this surgical subgroup (8.9 vs. 13.6 days). Significant left atrial enlargement and echocardiographic left atrial/aortic (LA/Ao) ratios of > 1.5:1 occurred in 58% or 171 of 290 surgical patients vs. 32% or 59 of 190 medical patients, (P < 0.001). During the first 3 yr of this study (medical treatment averaged 5 days), the duration of intubation in the surgical patients averaged 15.2 days; by comparison, in the last 2 yr of this study (medical treatment averaged 1-2 days), the duration of intubation was 6.5 days (P < 0.001). Necrotizing enterocolitis (NEC) occurred in 11% or 46 of 428 medical patients vs. 0.3% (1 of 305 patients) in the ligated group postoperatively (P < 0.001). Late deaths were related to lung disease, CNS problems, NEC and so on. Ligation of a significant PDA is associated with zero surgical risk, a reduced incidence of NEC, reduced duration of intubation, especially with early ligation and improvement in late survival. The surgical approach is the treatment of choice for a refractory PDA.