Surgical closure of persistent ductus arteriosus (PDA) in infants before 30 weeks gestation

Between October 1981 and December 1983 21 premature infants of mean gestational age 27.5 weeks (range 26-29 weeks) underwent surgical closure of persistent ductus arteriosus. Mean birth weight was 1080 g. There was no operative mortality. One death in an infant with pseudomonas septicaemia occurred two days after surgery. Twenty infants had features of idiopathic respiratory distress syndrome (IRDS) and required assisted ventilation prior to operation. Six infants had associated bronchopulmonary dysplasia (BPD) and 11 had signs of congestive cardiac failure. All infants presented with clinical features suggesting the diagnosis of PDA and in 18 the left atrial/aortic ratio was increased (mean 1.9:1). In 18 infants a trial of Indomethacin therapy had failed. This experience supports the view that surgical closure of PDA in infants born before 30 weeks gestation can be accomplished safely. We believe that surgical treatment of PDA represents the optimal therapy in this high risk group of infants.