Premature Infants with Patent Ductus Arteriosus and Respiratory Distress: Selection for Ductal Ligation

Abstract Operative treatment of patent ductus arteriosus (PDA) in premature infants with respiratory distress has been advocated when rapid and favorable response to medical management has not occurred. At Cincinnati Children's Hospital from September, 1971, to January, 1975, 28 patients with respiratory distress syndrome (RDS) and PDA underwent ductal ligation after failing to respond to intensive medical management. There were 15 survivors and 13 deaths, for a survival rate of 53%. We have found the most reliable assessment of PDA and its response to medical management to be a reduction in left cardiac chamber size as evidenced by echocardiography. In 15 of the 28 infants who underwent ligation, echocardiography showed that they had failed to respond to medical management. Seven of the group survived. During the same period 15 infants with RDS and PDA responded favorably to medical management and showed return of left cardiac chamber size to normal by serial echocardiograms. Of these, 11 survived and 4 died of noncardiac causes. Clinical improvement was corroborated without exception by echocardiographic demonstration of a reduction in size of the left cardiac chamber. We believe that infants who follow this course should not have ductus ligation. We contend that the choice of surgical candidates should be more selective since a survival rate of only 50% has been obtained in this and other series. Further, we have found that only 8 of 14 long-term survivors in our series are free from pulmonary disease.