The Journal of Thoracic and Cardiovascular Surgery, Vol 71, 169-178, Copyright © 1976 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Improving the results of ligation of patent ductus arteriosus in small preterm infants
RJ Nelson, DW Thibeault, GC Emmanouilides and M Lippmann
Thirty-two consecutive preterm infants with birth weights under 1,500 grams
and with respiratory distress syndrome (RDS) complicated by a patent ductus
arteriosus (PDA) underwent ligation of PDA. The indications for operation
were massive left-to-right shunting associated with heart failure
(cardiomegaly and pulmonary edema) unresponsive to medical treatment. The
clinical manifestations of heart failure were related to the severity of
RDS. Infants with mild-to- moderate RDS (21) often recovered and later
developed typical findings of PDA (bounding pulses, hyperactive precordium,
and murmur). They are now operated upon as soon as respiratory support is
required. Infants with severe RDS (11) develop cardiomegaly earlier, and
retrograde aortography may show massive left-to-right shunting before the
presence of a murmur. Ligation is indicated when blood-gas values
deteriorate despite medical treatment. Nineteen (59 per cent) of these
extremely preterm infants survived to be discharged and 16 (50 per cent)
are developing normally. Three have neurologic impariment. None of the
survivors has clinical respiratory disease, and their radiologic findings
of bronchopulmonary dysplasia are improving.