Korean J Thorac Cardiovasc Surg.  2013 Jun;46(3):178-184. 10.5090/kjtcs.2013.46.3.178.

Primary Surgical Closure Should Be Considered in Premature Neonates with Large Patent Ductus Arteriosus

• Ko SM
• Yoon YC
• Cho KH
• Lee YH
• Han IY
• Park KT
• Hwang YH
• Jun HJ

• KMID: 1427787
• DOI: http://doi.org/10.5090/kjtcs.2013.46.3.178

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.
MATERIALS AND 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 (> or =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).
CONCLUSION
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.

Keyword

Patent ductus arteriosus; Premature; Neonate

MeSH Terms

Bronchopulmonary Dysplasia
Ductus Arteriosus, Patent
Humans
Incidence
Infant
Infant, Newborn
Infant, Premature
Respiration, Artificial