Surgical Closure of the Ductus Arteriosus in Premature Infants

Abstract

During a 62-month period patent ductus arteriosus (PDA) was diagnosed in 88 premature infants with birth weights less than 1750 g. Twenty-one of these infants required operative closure of the PDA. Six infants had uncontrolled heart failure without associated pulmonary disease. Fifteen infants had severe idiopathic respiratory distress syndrome (IRDS) and required operation for deteriorating pulmonary function when heart failure developed. Twelve of these 15 infants weighed less than 1250 g at birth. The ductus arteriosus was ligated in 19 patients and was divided in two patients. The six infants without IRDS survived, and four are completely normal. Of 15 infants with IRDS eight had steady improvement in pulmonary function after operation. Three of these eight patients eventually died. In three infants pulmonary function improved slowly and in two patients pulmonary function did not improve after operation; all of these patients eventually died. Two patients died of peritonitis secondary to bowel ischemia. Of the five infants with IRDS who are alive, one is two months of age, two are moderately retarded in psychomotor development, and two, who developed hydrocephalus, are severely retarded. Although operation successfully controls heart failure in premature infants with PDA and IRDS, progressive pulmonary disease and the complications of extreme prematurity pre-empt good results in most of these infants.