Timing of surgery is at age1-2 years or whenever the diagnosis is made in an older child. In infants with CHF, pulmonary hypertension, or recurrent pneumonia, the operation is more urgent. Prostaglandins are utilized to maintain the patency of the ductus arteriosus until surgical ligation is performed. Prostaglandin - Promote vasodilatation by direct effect on the vasculature and smooth muscle of the ductus arteriosus. PGE1 is most effective in premature infants.
Onset of action is generally within min.
Patients presenting with CHF need anticongestive therapy followed by a definitive procedure to close the PDA by either surgery or catheterization. Repair of PDA is recommended for all patients with PDA because of the risk for endocarditis. Surgical morbidity and mortality rates are negligible. Transfer to a tertiary care center is mandatory for a patient in extremis presenting in florid CHF once stabilized with diuretics and positive pressure ventilation, as indicated. PGE1 should be used to maintain patency of the ductus arteriosus once it is established that a ductal dependent lesion exists.