Management of patent ductus arteriosus: a comparison of operative v pharmacologic treatment.

Over a 5-year period ending June 1986, 183 premature infants with evidence of a hemodynamically significant patent ductus arteriosus (PDA) associated with cardiopulmonary compromise underwent pharmacologic and/or surgical ductal manipulation. One hundred seven infants underwent surgical ligation and 76 initially received indomethacin. The average birth weight was 10% less and 1 week less for the surgically treated v the indomethacin-treated infants. Among the infants undergoing ligation, there were no failures of therapy and one surgically related complication. Among the infants receiving indomethacin, 42% failed to improve, and 84% of these infants required surgical intervention. Those infants who failed indomethacin therapy in general weighed less, had a shorter gestation and required prolonged ventilatory support. In no instance was death directly attributable to either therapeutic modality. Our data suggest that surgical ligation of hemodynamically significant PDA yields a more predictable result with low morbidity and no mortality. We believe it is the preferred treatment for premature infants less than 800 g.