Surgery Today

, Volume 28, Issue 12, pp 1290–1294

Ligation of medically refracted patent ductus arteriosus (PDA) in an extremely low body weight premature infant

  • Rameshwar Pokharel
  • Katsuya Hisano
  • Masao Yasufuku
  • Keiji Ataka
  • Masayoshi Okada
  • Seiji Yoshimoto
  • Hajime Nakamura
Case Reports

DOI: 10.1007/BF02482818

Cite this article as:
Pokharel, R., Hisano, K., Yasufuku, M. et al. Surg Today (1998) 28: 1290. doi:10.1007/BF02482818
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Abstract

Medically refracted patent ductus arteriosus (PDA) in an extremely low birth weight (ELBW) preterm (gestation 24 weeks 2 days) infant was successfully ligated under general anesthesia in the neonatal intensive care unit (NICU). Pharmacological agents are more effective to close PDA in preterm infants than in full-term infants, although within 48 h three doses of indomethacin were not sufficient to close PDA in this case. At the age of 69 h the infant developed severe symptoms including bradycardia, systemic hypotension, pulmonary hypertension, diastolic steal (reverse distal aorta flow velocity), and anuria. A PDA ligation was thus performed surgically at 72 h of age. General anesthesia and surgical stress were tolerated by this 531 g infant. Postoperatively all symptoms improved dramatically and the general conditions were stable. On the 38th day the endotracheal tube was extubated and on the 50th day nasogastric milk feeding was started. The oxygen supply was weaned on the 78th day. Growth and development until 6 months were within the normal range of very low birth weight infants. A surgical ligation as early as possible in medically refracted PDA in an ELBW infant is thus considered to be a safe and effective treatment. It prevents the development of further complications of cardiopulmonary vascular problems. Color Doppler echocardiography can reliably measure the PDA size, flow velocity, and hemodynamic changes of persistent PDA, even in tiny infants.

Key Words

preterm infant patent ductus arteriosus ligation of patent ductus arteriosus 

Copyright information

© Springer-Verlag 1998

Authors and Affiliations

  • Rameshwar Pokharel
    • 1
  • Katsuya Hisano
    • 1
  • Masao Yasufuku
    • 1
  • Keiji Ataka
    • 1
  • Masayoshi Okada
    • 1
  • Seiji Yoshimoto
    • 2
  • Hajime Nakamura
    • 2
  1. 1.Department of Surgery, Division IIKobe University School of MedicineKobeJapan
  2. 2.Department of PediatricsKobe University School of MedicineKobeJapan