[Surgical treatment of patent ductus arteriosus Botalli in the premature infant. Indications and results of treatment].

125 preterm infants with persistent ductus arteriosus (PDA) had surgical ligation between November 1978 and December 1984. In an additional case the situation was complicated by severe coarctation, which had not been diagnosed prior to surgery. The mean birth weight was 1340 +/- 448 g (85 infants weighed less than 1500 g). Gestational age was 30.6 +/- 2.5 weeks. Age at surgical ligation was 13 +/- 7 days for all patients. Preterm infants from our hospital were operated on with a mean age of 9.5 days. Indications for surgical ligation were clinical and radiographic signs of large PDA, during the last two years supported by the results of pulsed doppler ultrasonography. Only one preterm infant with PDA and coarctation died intraoperatively. The overall results showed a mortality rate of 21.6%. This rate has decreased from 30.4 to 11.7% in the last year. Important improvement could be obtained by early ligation, with carefully maintained body temperature during surgery. Preoperative ventilation parameters were kept constant and changes in arterial blood pressure during operation were avoided. The percentage of permanent handicaps was lowered from 15.2 to 5.9% in the last year of our study. According to failure of indomethacin therapy in the very beginning of PDA treatment, it is our policy now to ligate PDA in preterm infants early and without delay by a trial with indomethacin therapy.