Analysis of two cases of patent ductus arteriosus ligation in preterm identical twins and literature review

Objective:To investigate the timing and effect of surgical ligation in the treatment of patent ductus arteriosus(PDA)in preterm identical twins.Methods:Retrospective analysis was made on the treatment of 2 cases of preterm twins with hemodynamic significant PDA(hsPDA)with corresponding clinical manifestation in our neonatology department,and literatures of PDA ligation for preterm twins were retrieved.Results:These 2 cases were naturally conceived monochorionic diamniotic twins,with gestational age 30+2 weeks,birth weight was 1510g and 780g for larger twin and smaller twin,with birth weight discordance 48.3%.They both developed hsPDA with corresponding clinical manifestation,series Echocardiography showed evidence of left to right shunting and cardiac insufficiency which were left atrial and ventricular enlargement,large PDA(2.8~3.5mm),failed two courses of ibuprofen,N-terminal pro-brain natriuretic peptide level increased significantly,finally received surgical ligation with significant clinical improvement and no related complications.12 cases were found from literature search,including our 2 cases,of these,2 died,9 were cured and 1 improved significantly.Among 6 cases whose detailed information were available,4 infants were identical twins,2 unknown.Conclusions:Preterm identical twins have the same genetic basis,the possibility of PDA ligation for both the larger twin and smaller twin should be alerted if the gestaional age is small and birth weight discordance is above 30%.If preterm twins have hsPDA who may fail ibuprofen treatment,surgical ligation should be considered early,and it is safe and effective.

Is early patent ductus arteriosus ligation helpful in premature neonates? A 10-year retrospective study

Background To compare short and long outcomes between early(≤28 days)(EL)and late ligation(LL)groups.To explore factors predicting early extubation(≤7 days)after patent ductus arteriosus(PDA)ligation.Methods We conducted a single center,retrospective cohort study of preterm infants<32 weeks who underwent surgical ligation over a 10-year period(2009-2019).Results A total of 133 infants underwent PDA ligation,in the study period.Both groups had similar short-term outcome such as bronchopulmonary dysplasia(BPD)or death(96%vs.98%,P=0.64)and long-term clinical outcomes including Bayley's assessment at 2 years corrected age.Fewer infants in the EL group developed severe BPD(63%vs.81%,P=0.02).Age at ligation had adjusted odds ratio of 1.04 with over lapping confidence interval(95%CI 1.0-1.1,P=0.02)for severe BPD/death.There was no difference in day of extubation between the EL and LL group(8 days vs.7 days,P=0.85).Left atrium/aortic root ratio of ≥1.75 would give sensitivity of 41% and 80% specificity for early extubation(area under the curve of 0.61).There was marginal reduction of hospital stay in the EL group[113(105-121)days vs.115(107-123)days;log rank P=0.026].Conclusion EL can be delivered safely with a clinically important lower incidenee of severe BPD and shorter duration of hospital stay compared to LL.