Abstract
As intensive respiratory care is provided to more preterm infants with respiratory distress syndrome (RDS), heart failure from an associated PDA is being increasingly recognized. How ever, indications for surgery are not clearly defined. The clinical courses of 21 infants ≤ 30 wks. gestation with RDS and a PDA diagnosed by either single film aortography or surgery were analyzed. Two clinical patterns were identified. One, involving infants with severe RDS (8 cases) requiring high respirator pressures and the other with mild or moderate RDS (13 cases). Those infants with severe RDS showed some improvement by 3 days, but relapsed again requiring continuation of respiratory assistance. Four infants with massive cardiomegaly and pulmonary edema underwent ligation of PDA between 5-9 days. Aortography demonstrated massive left-to-right ductal shunt as early as 3 days. Therefore it is suggested that ligation of PDA should be performed at the time of relapse or a short time later. Those infants with mild or moderate RDS recovered from their disease within a few days. They subsequently developed persistent apnea associated with PDA and heart failure. Ten infants could not be weaned from the respirator and underwent ligation of PDA between 8-32 days. It is suggested that in this group of infants surgery should be performed at the time when respirator therapy is needed to control the heart failure.
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