Background: Elevation of pulmonary vascular resistance and the association of aneurysm or calcification may increase the surgical risk in adult patients with patent ductus arteriosus(PDA) and necessitate different surgical techniques. Methods: Charts of a series of 26 consequent adult patients who underwent PDA closure were reviewed retrospectively. The majority of the patients (85%) underwent cardiac catheterization. In these patients pulmonary vascular resistance (PVR) and pulmonary to systemic flow ratio (Qp/Qs) were calculated. PVR >8 Woods Unit (WU) was considered as contraindication for PDA closure. In the majority of the patients PDA was ligated (73%). Long-term follow-up was completed in 80% of the patients. A late postoperative echocardiographic evaluation for recanalization of the PDA and regression of pulmonary hypertension was performed in 15 patients Results: Of the total 26 patients, 21 were female, five were male. Mean age was 28 (range 18-54). Of the 22 patients who underwent cardiac catheterization, eight had mild, six had moderarate and five had severe pulmonary hypertension. Qp/Qs was calculated <2 in two, 2>3 in 12, 3>4 in seven patients and >4 in one patient. PVR was not higher than 8 WU in any patients. PVR was calculated <2 in 12, 2>4 in five, 4>6 in three and >6 in two patients. Aneurysm was observed in four and calcification was observed in two patients. There were no early or late mortality or morbidity. Mean follow-up was 44 months (range 1-47 months) A late postoperative echocardiographic evaluation of 15 patients revealed regression in pulmonary hypertension, and no recanalization was observed in patients whom ligation was chosen as surgical technique. Conclusion: Ligation of PDA is a safe technique in adult patients with mild or moderate pulmonary hypertension. However, in patients with severely elevated pulmonary artery pressure, closure should be conducted via a median sternotomy on cardiopulmonary bypass

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