Between January 1997 and June 2002, we retrospectively reviewed the records of all premature infants (birth weight less than 2000 g) admitted to the newborn intensive care unit (NICU) at Chi Mei Medical Center. Among the 399 premature infants (birth weight less than 2000 g) surviving more than one week, 111 infants were diagnosed with patent ductus arteriosus (PDA). Seventeen premature infants underwent surgical closure of PDA after failure of indomethacin treatment. The indication for surgical closure of PDA was ventilator dependence and/or congestive heart failure in infants with echocardiographic evidence of a ductus arteriosus. The mean gestational age and birth weight were 26.9 +/- 2.4 weeks (range 23-32 weeks) and 978.8 +/- 360.1 g (range 494-1920 g), respectively. The mean age and weight at the time of operation were 28.1 +/- 12.4 days (range 13-61 days) and 950.8 +/- 390.4 g (range 402-2120 g), respectively. All the operation procedures were performed in our NICU, using operating room personnel, thus eliminating the risks of patient transport. There was no intraoperative death. Three infants died in hospital due to other problems. One died of sepsis and the other two died due to bronchopulmonary dysplasia (BPD) and suspected sepsis. There were only two infants who had complications after surgical closure of PDA. One infant had left pneumothorax with subcutaneous emphysema and the other one had right upper lung collapse. We conclude that surgical closure of the PDA for the premature infant can be a safe and effective procedure performed in the NICU, when indomethacin closure is ineffective or contraindicated.