RT Book, Section A1 Fiore, Andrew C. A1 Hines, Michael A1 Pennington, D. Glenn A2 Ziegler, Moritz M. A2 Azizkhan, Richard G. A2 Allmen, Daniel von A2 Weber, Thomas R. SR Print(0) ID 1100437299 T1 The Surgical Treatment of Patent Ductus Arteriosus and Aortic Coarctation T2 Operative Pediatric Surgery, 2e YR 2014 FD 2014 PB McGraw-Hill Education PP New York, NY SN 978-0-07-162723-8 LK accesspediatrics.mhmedical.com/content.aspx?aid=1100437299 RD 2024/03/28 AB Key PointsFull-term neonates, infants, and older children should have patent ductus arteriosus (PDA) closed even in the absence of symptoms, provided the pulmonary vascular resistance is less than 8 to 10 wood units/m2.Ligation is reserved for preterm infants and small newborns.In full-term newborns and older children, the ductus arteriosus is divided whenever possible to avoid the rare complications of ductal recanalization or aneurysm formation following ligation.Closure using the midline sternotomy approach is most commonly employed for patients requiring cardiopulmonary bypass to correct a coexisting cardiac lesion.On rare occasions when the PDA cannot be encircled, it can be closed from inside the main pulmonary artery.The double-umbrella and vascular occluder are currently used for percutaneous catheter closure of PDA and Gianturco coils are becoming increasing popular.Endoscopic ductal closure can be applied to patients less than 3 to 5 kg, an important distinction from transcatheter closure, where femoral vessel size may be prohibitive.Complications of PDA closure include bleeding and aneurysm of the ductus arteriosus after ligation or division.The high complication rate following ductus ligation in preterm infants is related more to prematurity than to the surgery. About 5% to 10% of these premature patients develop sequellae, including retrolental fibroplasia, blindness, and cerebral palsy.