The pharmacological treatment of patent ductus arteriosus. A review of the evidence

Abstract

Modern heart surgery began with operative intervention for patent ductus arteriosus in 1938. Half a century later, ligation and division of patent ductus arteriosus in an infant or child remains a simple and safe surgical procedure for a lesion identified relatively easily. In the intervening years, paediatric cardiologists and surgeons have also directed their attention to the management of more complex congenital cardiac defects. Recently, however, there has been a significant reappraisal and re-emphasis of the role of patent ductus arteriosus in the context of neonatal cardiopulmonary disease. Interest has focused on: (a) surgical and pharmacological management of the premature infant with a large ductal left-to-right shunt in the context of respiratory distress syndrome; (b) preservation of patency in ductal-dependent congenital heart disease; and (c) ductal right-to-left shunting in persistence of the fetal circulation (PFC) syndrome or other diseases associated with increased pulmonary vascular resistance. This review examines the above conditions and reviews the progress and current status of drug therapy in the treatment of these disorders. Closure of the ductus arteriosus with cyclo-oxygenase inhibition as well as re-opening and maintaining patency of the ductus arteriosus with prostaglandin therapy is discussed.