We achieved satisfactory surgical outcomes in low birth
weight infants operated for isolated PDA. Fragility of
the tissues and also duct is a challenge on a low birth
weight infant compared to a normal weight one. We
paid attention to this severe complication, although we
did not use ligation technique when the duct appeared
fragile and hard to ligate.
In preterm infants, PDA can be challenging
to manage and definitive treatment is either
achieved by pharmacological means or surgery.
Traditionally, intravenous indomethacin has been
considered and a variety of dosing regimens have been proposed.[5] Additionally, ibuprofen, another
cyclo-oxygenase inhibitor, can be as effective as
indomethacin with fewer side effects.[10,11] In our
institution, we used indomethacin preoperatively.
As intravenous form of ibuprofen was not easily
accessible, peroral administration was applied in three
patients. When medical therapy fails or congestive
heart failure occurs, surgical closure of PDA may be
necessary.
If hemodynamically significant PDA is unable
to be closed or becomes significantly smaller
despite medical therapy, surgical closure is often
considered.[12,13] Surgery is also performed, if there are
contraindications to pharmacological treatment.[14]
Patent ductus arteriosus can be closed via
thoracotomy, sternotomy or minimally invasive
techniques.[15] Minimally invasive procedures may be
feasible in even premature babies[16] which seems to
be equally safe, although it is more time-consuming.
However, left thoracotomy, if applicable, is the most
common approach for isolated PDA in particular. We
perform posterolateral thoracotomy in all our patients
with isolated PDA.
Surgical closure of PDA can be achieved through
left posterolateral thoracotomy, left anterolateral
thoracotomy or midline sternotomy. Closure
technique of PDA includes ligation, division, closure
from inside the pulmonary artery or patch closure
under cardiopulmonary bypass, ligaclip occlusion,
transcatheter closure or video-assisted thoracoscopic
surgery.[8]
Prophylactic surgical ligation is a method
particularly in extremely low birth weight infants for
the prevention of mortality and morbidity; however,
this procedure remains an area of controversy. We used
this technique for only one patient who was on fourth
day of birth.
Furthermore, minimally dissection is
recommended to preserve intact tissues. After
careful evaluation we preferred double ligation
in our institution. On the other hand, surgical
complications including bleeding, recanalization,
recurrent laryngeal nerve injury, chylothorax, and
pneumothorax are uncommon.
In conclusion, despite the shortcomings of
retrospective design, we suggest that surgery may
be well-tolerated for isolated PDA in very low birth
weight infants with good results if the first-line
treatment by indomethacin or ibuprofen fails.
Declaration of conflicting interests
The authors declared no conflicts of interest with
respect to the authorship and/or publication of this
article.
Funding
The authors received no financial support for the
research and/or authorship of this article.