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Ligation of patent ductus arteriosus in premature infants
Insights
Patent ductus arteriosus (PDA) ligation in preterm infants has low surgical risk and improves heart and respiratory failure. Most survivors recovered well, though some developed bronchopulmonary dysplasia.
Area of Science:
- Neonatal Surgery
- Pediatric Cardiology
- Critical Care Medicine
Background:
- Patent ductus arteriosus (PDA) is a common condition in preterm infants, often leading to heart and respiratory complications.
- Surgical intervention for PDA is considered when medical management fails to resolve intractable congestive heart failure or progressive respiratory failure.
Purpose of the Study:
- To evaluate the safety and efficacy of surgical ligation of PDA in preterm infants.
- To assess the postoperative outcomes and long-term recovery in this patient population.
Main Methods:
- A retrospective review of 66 preterm infants undergoing PDA ligation.
- Analysis of intraoperative events, postoperative complications, mortality, and long-term follow-up data.
Main Results:
- No intraoperative deaths occurred. Postoperative mortality was 22.7% (15/66), with major causes including intracranial bleeding and coagulopathy.
- Significant improvement in cardiac function (left atrium to aorta ratio reduced from 1.56 to 1.02, p=0.05) and respiratory status was observed in many patients.
- Long-term follow-up (1-5 years) of 51 survivors revealed good recovery in nearly two-thirds, with 1 late death. Bronchopulmonary dysplasia was noted in 17 survivors, requiring longer ventilation.
Conclusions:
- PDA ligation in preterm infants is associated with low intraoperative risk and offers significant benefits for patients with heart and respiratory failure.
- While postoperative complications and mortality exist, long-term outcomes are favorable for a majority of survivors.
- Bronchopulmonary dysplasia remains a concern in survivors, necessitating careful monitoring and management.
Abstract:
In the operating room, 66 preterm infants weighing between 710 and 2,700 gm (23 less than 1,000 gm) underwent ligation of a patent ductus arteriosus (PDA). Respiratory distress syndrome was present in 53 patients; the rest had apnea-bradycardia syndrome. PDA ligation was indicated for intractable congestive heart failure in 52 patients or progressive respiratory failure in 14. There were no intraoperative deaths. Fifteen infants died 1 to 120 days postoperatively. Seven deaths resulted from intracranial bleeding, 3 from diffuse coagulopathy, and 1 from respiratory failure. The condition of patients with heart failure improved postoperatively, with the mean left atrium to aorta ratio reduced from 1.56 to 1.02 (p = 0.05). Respiratory function improved in 25 patients extubated by the third postoperative day. Late follow-up (one to five years) of the 51 survivors showed 1 late death. Seventeen survivors had roentgenographic evidence of bronchopulmonary dysplasia. Infants with bronchopulmonary dysplasia required longer postoperative ventilation (mean, 21.5 days compared with 4.75 days). Twenty-four infants were normal. Ligation of PDA in preterm infants has low intraoperative risk and improves the condition of those with heart and respiratory failure. Late follow-up showed good recovery of nearly two-thirds of the patients.