Surgical Closure of Patent Ductus Arteriosus in Premature Neonates Weighing Less Than 1,000 grams: Contemporary Outcomes

Objective: The safety of surgical closure of patent ductus arteriosus (PDA) in very low birth weight premature neonates has been questioned because of associated morbidities. However, these studies are vulnerable to significant bias as surgical ligation has historically been utilized as “rescue” therapy. The objective of this study was to review our institutions’ outcomes of surgical PDA ligation. Methods: All neonates with operative weight of ≤1.00 kg undergoing surgical PDA ligation from 2003 to 2015 were analyzed. Records were queried to identify surgical complications, perioperative morbidity, and mortality. Outcomes included pre- and postoperative ventilator requirements, pre- and postoperative inotropic support, acute kidney injury, surgical complications, and 30-day mortality. Results: One hundred sixty-six preterm neonates underwent surgical ligation. One hundred twenty-one (70.3%) had failed indomethacin closure. One hundred sixty-four (98.8%) patients required mechanical ventilation prior to surgery. At 17 postoperative days, freedom from the ventilator reached 50%. Of 109 (66.4%) patients requiring prolonged preoperative inotropic support, 59 (54.1%) were liberated from inotropes by postoperative day 1. Surgical morbidity was encountered in four neonates (2.4%): two (1.2%) patients had a postoperative pneumothorax requiring tube thoracostomy, one (0.6%) patient had a recurrent laryngeal nerve injury, and one (0.6%) patient had significant intraoperative bleeding. The 30-day all-cause mortality was 1.8% (n = 3); no deaths occurred intraoperatively. Conclusion: In this retrospective investigation, surgical PDA closure was associated with low 30-day mortality and minimal morbidity and resulted in rapid discontinuation of inotropic support and weaning from mechanical ventilation. Given the safety of this intervention, surgical PDA ligation merits consideration in the management strategy of the preterm neonate with a PDA.

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Surgical closure of patent ductus arteriosus in premature neonates: Does the surgical technique affect the outcome?

Anales de Pediatría (English Edition) ◽

10.1016/j.anpede.2015.12.005 ◽

2017 ◽

Vol 86 (5) ◽

pp. 277-283 ◽

Cited By ~ 1

Author(s):

Alejandro Avila-Alvarez ◽

Marta Serantes Lourido ◽

Rebeca Barriga Bujan ◽

Carolina Blanco Rodriguez ◽

Francisco Portela-Torron ◽

...

Keyword(s):

Surgical Technique ◽

Patent Ductus Arteriosus ◽

Ductus Arteriosus ◽

Premature Neonates ◽

Surgical Closure ◽

Patent Ductus

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Why Not Use Oxygen to Close PDAs

PEDIATRICS ◽

10.1542/peds.65.4.863b ◽

1980 ◽

Vol 65 (4) ◽

pp. 863-864

Author(s):

Itsuro Yamanouchi ◽

Ikuko Igarashi

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Patent Ductus Arteriosus ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Ductus Arteriosus ◽

Surgical Closure ◽

Surgical Ligation ◽

Patent Ductus

Patent ductus arteriosus (PDA) has become very common in modern nurseries in recent years. The favorite methods of managing it are either doing nothing, giving indomethacin, or surgical closure. The initial enthusiasm for the use of indomethacin to induce closure is now being tempered as a result of experience. Early surgical ligation of PDA, especially that complicating respiratory distress syndrome, is considered too aggressive for extremely small preterm infants, and for the management of infants having congestive heart failure.

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Primary Surgical Closure Should Be Considered in Premature Neonates with Large Patent Ductus Arteriosus

The Korean Journal of Thoracic and Cardiovascular Surgery ◽

10.5090/kjtcs.2013.46.3.178 ◽

2013 ◽

Vol 46 (3) ◽

pp. 178-184 ◽

Cited By ~ 2

Author(s):

Seong-Min Ko ◽

Young Chul Yoon ◽

Kwang-Hyun Cho ◽

Yang-Haeng Lee ◽

Il-Yong Han ◽

...

Keyword(s):

Patent Ductus Arteriosus ◽

Ductus Arteriosus ◽

Premature Neonates ◽

Surgical Closure ◽

Patent Ductus

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Left ventricular dysfunction postsurgical patent ductus arteriosus ligation in children: predictor factors analysis

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-019-0990-z ◽

2019 ◽

Vol 14 (1) ◽

Author(s):

Mohamed Abdel-Bary ◽

Khaled Abdalla Abdel-Baseer ◽

Ahmed Fathy Abdel-Latif ◽

Mohamed Abdella Abdel-Naser ◽

Mahmoud Nafie ◽

...

Keyword(s):

Patent Ductus Arteriosus ◽

Systolic Function ◽

Ductus Arteriosus ◽

Left Ventricular ◽

Surgical Ligation ◽

Number Of Patients ◽

Pda Ligation ◽

The Mean ◽

Predictor Factors ◽

Patent Ductus

Abstract Objective To identify the predictor factors of left ventricular (LV) dysfunction following patent ductus arteriosus (PDA) surgical ligation. Background PDA is viewed as a noticeable amongst the most widely recognized congenital heart defects in children and its closure is responsible for many hemodynamic changes that require intervention and care. Methods A retrospective study included fifty children with isolated PDA treated by surgical ligation from June 2015 to June 2018. The LV dimensions and systolic function were assessed by two-dimensional echocardiography pre and post PDA ligation. All cases were followed-up on the first-day, 1 month and 6 months post ligation. Results The mean age of cases was 15.78 ± 7.58 months and 72% were females. The mean duct size was 4.08 ± 1.25 mm. There was a marked decrease in LVEDd, LA/Ao, EF and FS in the first-day post ligation contrasted with pre ligation values. Moreover, an amazing decline in LVEDd and LA/Ao ratio was observed 1 month post ligation contrasted with the early post ligation status with asynchronous improvement of FS and EF at one and 6 months postoperatively. Conclusion PDA ligation is associated with a noteworthy LV systolic dysfunction within the first day post ligation; that in a significant number of patients may require anti-failure measures, prolong the hospital stay and necessitate a regular follow up and monitoring of LV function. PDA size, age, preoperative LVEDd and FS can be considered as predictor factors for suspicion of acute decrease in the LV systolic function early post PDA ligation. Trial registration ClinTrial.Gov NCT04018079.

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1071 Is low platelet count at start of medical treatment for patent ductus arteriosus (PDA) ligation a predictor of requirement for surgical ligation?

10.1136/archdischild-2021-rcpch.375 ◽

2021 ◽

Author(s):

Annelies Mitchell ◽

Richard Thwaites

Keyword(s):

Platelet Count ◽

Patent Ductus Arteriosus ◽

Medical Treatment ◽

Ductus Arteriosus ◽

Surgical Ligation ◽

Pda Ligation ◽

Low Platelet Count ◽

Patent Ductus

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Ligation of left pulmonary artery instead of patent ductus arteriosus

Cardiology in the Young ◽

10.1017/s1047951120002784 ◽

2020 ◽

Vol 30 (12) ◽

pp. 1943-1945

Author(s):

Semih Murat Yucel ◽

Irfan Oguz Sahin

Keyword(s):

Surgical Treatment ◽

Pulmonary Artery ◽

Patent Ductus Arteriosus ◽

Surgical Complication ◽

Ductus Arteriosus ◽

Left Pulmonary Artery ◽

Artery Ligation ◽

Surgical Closure ◽

Post Operative Period ◽

Patent Ductus

AbstractDuctus arteriosus is an essential component of fetal circulation. Due to occurring changes in the cardiopulmonary system physiology after birth, ductus arteriosus closes. Patent ductus arteriosus can be closed by medical or invasive (percutaneous or surgical) treatment methods. Percutaneous or surgical closure of patent ductus arteriosus can be performed for the cases that medical closure failed. Surgical treatment is often preferred method for closure of patent ductus arteriosus in the neonatal period. The most common surgical complications are pneumothorax, recurrent laryngeal nerve injury, bleeding, and recanalisation. A very rare surgical complication is left pulmonary artery ligation that has been presented in a few cases in the literature. Echocardiography control should be performed in the early post-operative period, especially in patients with clinical suspicion. If reoperation is required, it should never be delayed. We report a newborn patient whose left pulmonary artery ligated accidentally during patent ductus arteriosus closure surgery and surgical correction of this complication at the early post-operative period.

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