Surgical closure of PDA in low-weight premature infants
Rafik Margaryan1, Luigi Arcieri, Bruno Murzi
1U.O. Cardiochirurgia Pediatrica, Ospedale G. Pasquinucci, Fondazione G. Monasterio, Massa, Italy. raffdoc@gmail.com
Insights
Surgical closure of patent ductus arteriosus (PDA) is a safe and effective option for low-weight premature neonates when medical treatments fail. This approach offers a viable solution for managing hemodynamically significant PDA in critically ill infants.
Area of Science:
- Neonatal Surgery
- Pediatric Cardiology
- Critical Care Medicine
Background:
- Low-weight premature neonates (LWPNs) often develop hemodynamically significant patent ductus arteriosus (PDA), leading to severe complications.
- Cyclooxygenase inhibitors are the primary medical treatment for PDA closure.
- Surgical intervention is considered when medical management proves ineffective.
Purpose of the Study:
- To present the experience with surgical closure of PDA in LWPNs since 2006.
- To evaluate the safety and efficacy of surgical PDA closure in this vulnerable population.
Main Methods:
- Retrospective analysis of 518 LWPNs from 2006-2009, with 109 (21%) diagnosed with PDA.
- 19 infants (17%) underwent surgical PDA closure after medical treatment failure.
- Surgical closure was performed via left lateral thoracotomy, utilizing metallic haemoclips.
Main Results:
- Zero early mortality (0%) associated with surgical PDA closure.
- Post-operative care involved inotropic and diuretic support, along with advanced ventilatory management.
Conclusions:
- Surgical PDA closure in LWPNs is typically reserved for cases where medical treatment fails.
- The decision to transition to surgical closure should be guided by clinical status and echocardiographic findings.
- Surgical PDA closure is a safe and effective procedure for extremely low-weight premature neonates within the neonatal intensive care unit setting.
Unlabelled:
Low-weight premature neonates (LWPNs) frequently have haemodynamically significant patent ductus arteriosus (PDA) responsible for serious complications. Cyclooxygenase inhibitors are used for ductal closure. If the medical treatment fails, the PDA can be legated surgically. We present our experience, since 2006, on PDA surgical closure.
Material And Methods:
From 2006 to 2009, of the 518 LWPNs, PDA was present in 109 (21%) infants. The mean gestational age was 29.1 weeks. All patients underwent a medical treatment for PDA closure. Because of the failure of medical treatment, 19 patients (17%) underwent surgical closure. The shift from medical to surgical treatment was related to clinical condition and the echocardiographic appearance of PDA. At operation, the mean age was 17 days (9-42 days). The operation was performed through a left lateral thoracotomy in third intercostal space. PDA was clipped with metallic haemoclipps.
Results:
No LWPN died as a result of operation (0% early mortality). Post-operative period required inotrophic and diuretic infusion and a more aggressive ventilatory management.
Discussion:
In LWPNs, surgical PDA closure is usually given when medical treatment fails. The shift from medical to surgical closure should be based on clinical conditions being surgical PDA closure in the neonatal intensive care unit safe and effective also in extremely LWPNs.
