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Significant left-to-right shunting through the PDA was observed after 29\u00a0h, 14\u00a0h, 3\u00a0h, 7\u00a0h, and 5\u00a0h of ECMO treatment, respectively, at which point successful PDA ligation was performed. The surgical durations were 52\u00a0min, 45\u00a0min, 55\u00a0min, 50\u00a0min, and 40\u00a0min, respectively. Post-ligation, blood lactate levels significantly decreased compared to preoperative values. Four patients were successfully weaned off ECMO, with ECMO support durations of 64\u00a0h, 92\u00a0h, 70\u00a0h, and 87\u00a0h, respectively. After ECMO removal, mechanical ventilation was discontinued after 5.2 days, 7.2 days, 9.5 days, and 5.5 days, respectively. None of the four surviving patients experienced complications such as residual shunting, bleeding, chylothorax, neurologic injury, pneumothorax, poor wound healing, or sepsis.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>During ECMO treatment for PPHN in newborns with large PDAs, the direction of blood flow through the PDA should be closely monitored. PDA ligation is a feasible and reasonable intervention when pulmonary artery pressure decreases and left-to-right shunting through the PDA becomes evident.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s13052-024-01821-8","type":"journal-article","created":{"date-parts":[[2024,11,22]],"date-time":"2024-11-22T13:45:10Z","timestamp":1732283110000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Experience of patent ductus arteriosus ligation during extracorporeal membrane oxygenation treatment in newborns with severe respiratory failure due to persistent pulmonary hypertension: a single-center retrospective study"],"prefix":"10.1186","volume":"50","author":[{"given":"Qi-Liang","family":"Zhang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yi-Nan","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ya-Ting","family":"Zeng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yi-Rong","family":"Zheng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3768-9000","authenticated-orcid":false,"given":"Qiang","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2024,11,22]]},"reference":[{"issue":"4","key":"1821_CR1","doi-asserted-by":"publisher","first-page":"101381","DOI":"10.1016\/j.siny.2022.101381","volume":"27","author":"D Sankaran","year":"2022","unstructured":"Sankaran D, Lakshminrusimha S. 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