[Indomethacin or ligation in the treatment of persistent ductus arteriosus: a report of clinical experiences].

A haemodynamically significant, patent ductus arteriosus in mechanically ventilated preterm infants can be closed by two means today, either medical or surgical. The aim of our project was to compare the efficiency of these two kinds of therapy over a period of two years in condition that the indication for closing was given in all cases according to the same principles. The PDA was closed by ligation in 16 cases, by medical means (Indomethacin) in 15 cases. The outcome was significant different. 93% of the preterm infants treated with Indomethacin survived, but only 56% of the ligation-group, the main cause of death was the broncho-pulmonary dysplasia. The reason was the posterior day of life at the time of ligation compared with the Indomethacin-group. The broncho-pulmonary dysplasia is the result of pulmonary overcirculation because of prolonged patiency of the PDA. Only preparatory reasons were responsible for the delay of the day of ligation (organisation of the paediatric surgical crew including anesthesia), whereas the beginning of the medical therapy could be decided autonomously and therefore the period of pulmonary overcirculation could be shortened.