Surgery vs Indomethacin for PDA

[Delacroix22]

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So I'm getting mixed signals about when medical closure is indicated and surgical closure is indicated for a PDA.

Step up to Medicine is super cryptic:

"Treatment:
1. if pulmonary vascular disease is absent: surgical ligation
2. if severe pulmonary HTN or right-to-left shunt is present, do not correct the PDA. Surgery is contraindicated"

So if no pulmonary disease, surgery. If pulmonary disease... don't close it PERIOD... or don't close it using surgery (and use indomethacin instead).

Dynamed, medscape, and google aren't much help

 

[Zully]

Surgically close if:
1) The child is SYMPTOMATIC
2) Evidence of Left sided overload (so LVH)
3) pulmonary hypertension (these guys are going to develop Eisenmenger)
4) hx endocarditis