The evolution of ductus arteriosus treatment

The treatment of patent ductus arteriosus (PDA) has evolved over the years. We reviewed 231 non-premature children (group 1) undergoing surgical closu re of a PDA between January 1985 and December 1997, and 30 children (group 2) undergoing transcatheter closure from May 1995 to December 1998. The med ian age and weight at operation in group 1 were 13 months (range, 0.5-174 m onths) and 9.5 kg (range, 1.9-49.7 kg), respectively. There was one intra-o perative death (0.4%) secondary to hemorrhage. Immediate extubation was per formed in 208 patients (90%). Intra-operative chest tube use decreased from 73.3% to 10% between the 1985-88 and 1996-97 periods (P < 0.001). Postoper ative pneumothoraces occurred in 33/131 (25%) patients with only one patien t (0.7%) requiring drainage. Eleven patients had complications including wo und infection in four, vocal cord paralysis in three, and left pulmonary ar tery stenosis in one. The median length of stay (LOS) was 5 days (range, 2- 43 days). Follow-up echocardiogram was performed in 146/230 patients (63%) and revealed a residual PDA in six (4%); two being re-ligated, two remainin g clinically insignificant, and two spontaneously resolved at 7 and 28 mont hs follow-up. The remaining 84 patients had no clinical signs of a residual PDA. In group 2,where a transcatheter coil occlusion technique was used, t he median age and weight at procedure were 31 months (range, 9-320 months) and 14.9 kg (range, 9-69.7 kg), respectively. Vascular complications occurr ed in four patients (13.3%). One patient developed hemolysis and hemoglobin uria requiring hospital admission. Four patients required a second interven tion. At the most recent echocardiographic assessment, four patients (13.3% ) had a residual PDA.