Short-Term Outcome of PDA Ligation in the Preterm Infants at King Chulalongkorn Memorial Hospital, Thailand
Vichai Benjacholmas MD*, Jule Namchaisiri MD*, Pornthep Lertsarpcharoen MD**, Santi Punnahitananda MD**, Pimolrat Thaithumyanon MD**
Affiliation : * Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand ** Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
Background : Failure of the ductus arteriosus to close after medical treatment is usually associated with many
severe cardio-respiratory morbidities. Therefore, surgical ligation of symptomatic PDA is indicated in preterm
newborn infants who do not respond or have contraindication of medical treatment.
Objective : To report the short-term outcomes of PDA ligation in preterm infants at a tertiary care hospital in
Thailand.
Material and Method: Medical records of 42 preterm infants who underwent surgical ligation of PDA at King
Chulalongkorn Memorial Hospital were reviewed. All of the infants had symptomatic PDA that failed to
respond to medical treatment or had a contraindication to indomethacin or ibuprofen. Surgical ligation of
PDA was performed under general anesthesia. Morbidity and mortality occurring during hospitalization
were reported.
Results : There were 42 preterm infants in the present study. All of them had large PDA with intractable
congestive heart failure. Mean + SD of birth weight and gestational age were 1,206 + 567 grams and 28.7 +
3.6 weeks respectively. Mean + SD of the infants’ weight and age at the time of surgery were 1,089 + 549 grams
and 17.5 + 12 days respectively. Data on the size of PDA was available on 21 preterm infants. Their ductus
diameter (Mean + SD) was 3.1 + 1.1 mm. All infants were successfully extubated after PDA ligation. Twelve
events of complications occurred in 11 infants (26.7%). All of the complications were of mild degree and
resolved within a few days except one infant with left phrenic nerve injury that needed surgical plication of the
diaphragm. Two infants died at 37 and 160 days after surgery and the latter infant developed IVH grade IV on
the 15th day postoperatively. These complications were probably not related to PDA ligation.
Conclusion : PDA ligation was performed successfully on 42 preterm infants who had medical failure or had
contraindication to medical treatment. Cardio-respiratory illnesses improved significantly after ligation.
Two infant mortalities were not related to the procedure. Overall complication of surgery was 26.7% and
resolved without sequelae.
Keywords : Patent ductus arteriosus, Infant, Very low birth weight Ligation
