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The Annals of Thoracic Surgery, Vol 36, 561-566, Copyright © 1983 by The Society of Thoracic Surgeons
C Mavroudis, LN Cook, JW Fleischaker, HS Nagaraj, RJ Shott, WR Howe and LA Gray Jr
A previous report from our institution analyzed the results of
pharmacological (indomethacin) closure of patent ductus arteriosus (PDA) in
82 neonates. Closure was achieved in 54 patients. However, gastrointestinal
complications occurred in 21, necrotizing enterocolitis in 13, and focal
perforation in 8. Overall mortality in the indomethacin group was 40%. This
paper compares the results of that pharmacological experience with our
subsequent surgical experience with 86 low-birth-weight neonates for whom
gestational age, size, illness, and mode of diagnosis were comparable. Mean
weight at operation for this study was 1.1 kg; mean gestational age was
29.1 weeks. All infants required endotracheal-assisted ventilation for
severe radiographic and clinical hyaline membrane disease. Range-gated
Doppler study, retrograde flush aortography, and echocardiographic
measurement of the ratio between the left atrium and the aortic root were
used to confirm the diagnosis of PDA. Ligation was done in the neonatal
intensive care unit using local anesthesia supplemented with morphine.
Ventilation was controlled by an inhalation therapist; drug and blood
administration were controlled by the infant's nurse. Surgical ligation was
employed in all infants except for 7 in whom hemoclip ductal closure was
chosen because of extreme instability, coagulopathy, or ductal perforation.
There were no operative deaths. Surgical morbidity included ductal
perforation (2 patients), wound infection (1), and phrenic nerve injury
(1). Necrotizing enterocolitis occurred in 9 patients. The overall
mortality was 17%. Patients with preoperative pneumo-thorax had a 32%
overall mortality.(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Management of patent ductus arteriosus in the premature infant: indomethacin versus ligation
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