TY - JOUR
T1 - Management of Patent Ductus Arteriosus in the Premature Infant
T2 - Indomethacin versus Ligation
AU - Mavroudis, Constantine
AU - Cook, Larry N.
AU - Fleischaker, Jennifer W.
AU - Nagaraj, Hirikati S.
AU - Shott, Roger J.
AU - Howe, W. Robin
AU - Gray, Laman A.
PY - 1983/1/1
Y1 - 1983/1/1
N2 - A previous report from our institution analyzed the results of pharmacological (indomethacin) closure of patent ductus arteriosus (PDA) in 82 neonates. Closure was achieved in 54 patients. However, gastrointestinal complications occurred in 21, necrotizing enterocolitis in 13, and focal perforation in 8. Overall mortality in the indomethacin group was 40%. This paper compares the results of that pharmacological experience with our subsequent surgical experience with 86 low-birth-weight neonates for whom gestational age, size, illness, and mode of diagnosis were comparable. Mean weight at operation for this study was 1.1 kg; mean gestational age was 29.1 weeks. All infants required endotracheal-assisted ventilation for severe radiographic and clinical hyaline membrane disease. Range-gated Doppler study, retrograde flush aortography, and echocardiographic measurement of the ratio between the left atrium and the aortic root were used to confirm the diagnosis of PDA. Ligation was done in the neonatal intensive care unit using local anesthesia supplemented with morphine. Ventilation was controlled by an inhalation therapist; drug and blood administration were controlled by the infant's nurse. Surgical ligation was employed in all infants except for 7 in whom hemoclip ductal closure was chosen because of extreme instability, coagulopathy, or ductal perforation. There were no operative deaths. Surgical morbidity included ductal perforation (2 patients), wound infection (1), and phrenic nerve injury (1). Necrotizing enterocolitis occurred in 9 patients. The overall mortality was 17%. Patients with preoperative pneumothorax had a 32% overall mortality. Surgical closure of PDA can be accomplished safely with minimal anesthesia in an in-unit operating room. Hemoclip PDA closure can be used effectively in the occasional patient whose condition is unstable. Success is universal, and complications of indomethacin therapy are avoided.
AB - A previous report from our institution analyzed the results of pharmacological (indomethacin) closure of patent ductus arteriosus (PDA) in 82 neonates. Closure was achieved in 54 patients. However, gastrointestinal complications occurred in 21, necrotizing enterocolitis in 13, and focal perforation in 8. Overall mortality in the indomethacin group was 40%. This paper compares the results of that pharmacological experience with our subsequent surgical experience with 86 low-birth-weight neonates for whom gestational age, size, illness, and mode of diagnosis were comparable. Mean weight at operation for this study was 1.1 kg; mean gestational age was 29.1 weeks. All infants required endotracheal-assisted ventilation for severe radiographic and clinical hyaline membrane disease. Range-gated Doppler study, retrograde flush aortography, and echocardiographic measurement of the ratio between the left atrium and the aortic root were used to confirm the diagnosis of PDA. Ligation was done in the neonatal intensive care unit using local anesthesia supplemented with morphine. Ventilation was controlled by an inhalation therapist; drug and blood administration were controlled by the infant's nurse. Surgical ligation was employed in all infants except for 7 in whom hemoclip ductal closure was chosen because of extreme instability, coagulopathy, or ductal perforation. There were no operative deaths. Surgical morbidity included ductal perforation (2 patients), wound infection (1), and phrenic nerve injury (1). Necrotizing enterocolitis occurred in 9 patients. The overall mortality was 17%. Patients with preoperative pneumothorax had a 32% overall mortality. Surgical closure of PDA can be accomplished safely with minimal anesthesia in an in-unit operating room. Hemoclip PDA closure can be used effectively in the occasional patient whose condition is unstable. Success is universal, and complications of indomethacin therapy are avoided.
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U2 - 10.1016/S0003-4975(10)60686-8
DO - 10.1016/S0003-4975(10)60686-8
M3 - Article
C2 - 6639194
AN - SCOPUS:0020605303
SN - 0003-4975
VL - 36
SP - 561
EP - 566
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 5
ER -