Does the risk of infective endarteritis justify routine patent ductus arteriosus closure?

Abstract

The risk of infective endarteritis in patients with patent ductus arteriosus seems to have declined during the last 30-40 years, and cases of patent ductus arteriosus complicated by infective endarteritis are now very rare. Moreover, with the introduction of antibiotics, there has been a dramatic reduction in mortality from infective endocarditis. Despite these changes, however, the prevention of infective endarteritis has remained the principal indication, apart from haemodynamic reasons, for surgical patent ductus arteriosus closure. The aim of this study was to ascertain whether prevention of infective endarteritis is still a justifiable indication for routine closure in all cases of patient ductus arterious. The records of 270 paediatric and adult cases of patent ductus arteriosus was reviewed with respect to infective endarteritis. All Swedish death certificates issued during the period 1960-93 were checked for the occurrence of patent ductus arteriosus in combination with infective endarteritis. There had been no cases of infective endarteritis over an aggregate of 1196 years at risk. Of nearly three million deaths in Sweden during the period 1960-93 two cases were due to infective endarteritis as a complication of patent ductus arteriosus. The present findings suggest routine closure of a patent ductus arteriosus, for the sole purpose of eliminating the risk of infective endarteritis, is unnecessary.