Patent Ductus Arteriosus Closure / Surgery In India

What Is Patent Ductus Arteriosus ?

What Causes Patent Ductus Arteriosus ?
What Are the Signs and Symptoms of Patent Ductus Arteriosus ?
How Is Patent Ductus Arteriosus Diagnosed ?
Tests for Patent Ductus Arteriosus
Treatment for patent ductus arteriosus
Post-procedure care for your child
What Is Patent Ductus Arteriosus ?

Patent ductus arteriosus (PDA) is a Congenital defect in which the temporary blood vessel
connecting the left pulmonary artery to the aorta in the fetal heart fails to close after birth. In the
fetal heart, blood bypasses the lungs and gets oxygen from the placenta. But when the newborn's
lungs take over at birth, the body stops producing the chemicals that keep the ductus arteriosus
open, and it closes naturally.
If the ductus arteriosus fails to close completely, the baby has PDA. While this problem is rare, it
is sometimes associated with mothers who have had German measles (rubella) during pregnancy
and with infants born before their due date (prematurely). The result of this defect is that too
much blood travels to the lungs. The severity of the problem depends on how large the opening
is and how prematurely the baby was born.

Figure A shows the normal anatomy and blood flow of the interior of the heart. Figure B shows a
heart with a patent ductus arteriosus. The defect connects the aorta with the pulmonary artery,
allowing oxygen-rich blood from the aorta to mix with oxygen-poor blood in the pulmonary
artery.

A PDA is a type of congenital heart defect. A congenital heart defect is any type of heart problem
that is present at birth. If your baby has a PDA, but has an otherwise normal heart, the PDA may
shrink and go away completely, or it may need to be treated to close it. But, if your baby is born
with certain types of heart defects that decrease blood flow from the heart to the lungs or the
body, medicine may be given to keep the ductus arteriosus open to maintain blood flow and
oxygen levels until corrective surgery for the heart defect(s) can be performed.
About 3,000 infants are diagnosed with PDA each year in the United States. It is more common
in premature infants (babies born too early) but does occur in full-term infants. Premature babies
with PDA are more vulnerable to its effects. PDA is twice as common in girls as in boys.

What Causes Patent Ductus Arteriosus ?

The cause of patent ductus arteriosus (PDA) is not known. Genetics may play a role. A defect in
one or more genes could prevent the ductus arteriosus from closing normally after birth.
PDA is more common in : -

Premature infants (babies born too early)

Infants with genetic abnormalities such as Down syndrome

Infants whose mother had German measles (rubella) during pregnancy

What Are the Signs and Symptoms of Patent Ductus Arteriosus ?

A heart murmur may be the only sign that a baby has patent ductus arteriosus (PDA). A heart
murmur is an extra or unusual sound heard during the heartbeat.
Some infants may develop signs or symptoms of volume overload on the heart and excess blood
flow in the lungs.
Signs and symptoms may include : -

Fast breathing, working hard to breathe, or shortness of breath, or in the case of a

premature infant, need for increased oxygen or ventilatory support

Poor feeding and poor weight gain

Tiring easily

Sweating with exertion (such as while feeding)

How Is Patent Ductus Arteriosus Diagnosed ?

In full-term infants, a patent ductus arteriosus (PDA) usually is first suspected when the baby's
doctor hears a heart murmur during a regular checkup. If a PDA is large, the infant may also
develop symptoms of volume overload and increased blood flow to the lungs. When a PDA is
small, it may not be diagnosed until later in childhood. Once a PDA is suspected, a consultation
with a pediatric cardiologist will be arranged. A pediatric cardiologist is a doctor who specializes
in diagnosing and treating heart problems in children.
In premature babies (babies born too early) with PDA, the physical signs that are seen in fullterm babies, such as heart murmur, may not be present. Doctors may suspect a PDA in premature
babies who develop breathing difficulties soon after birth. Doctors use tests such as
echocardiography to look for PDA in premature babies with breathing problems.
Tests for Patent Ductus Arteriosus

Two painless tests are used to diagnose a PDA.

Echocardiogram :- This test, which is harmless and painless, uses sound waves to create a
moving picture of your baby's heart. During an echocardiogram, reflected sound waves
outline the heart's structure completely. The test allows the doctor to clearly see any
problem with the way the heart is formed or the way it's working. An echocardiogram is
the most important test available to your baby's cardiologist to both diagnose a heart
problem and follow the problem over time. In babies with PDA, the echocardiogram
shows how big the ductus is and how well the heart is responding to it. When medical
treatments are used to try to close a ductus in premature babies, echocardiograms are
used to see how well the treatment is working.

EKG (electrocardiogram) : - This test records the electrical activity in the heart. In the
case of a PDA, it can show:
o Enlargement of the heart chambers
o Other subtle changes that can suggest the presence of a PDA

Treatment for patent ductus arteriosus

Specific treatment for PDA will be determined by your child's physician based on : -

your child's age, overall health, and medical history

extent of the disease

your child's tolerance for specific medications, procedures, or therapies

expectations for the course of the disease

your opinion or preference

A small patent ductus arteriosus may close spontaneously as your child grows. A PDA that
causes symptoms will require medical management, and possibly even surgical repair. Your
child's cardiologist will check periodically to see whether the PDA is closing on its own. If a
PDA does not close on its own, it will be repaired to prevent lung problems that will develop
from long-time exposure to extra blood flow.
Treatment may include : -

medical management
In premature infants, an intravenous (IV) medication called indomethacin may help close
a patent ductus arteriosus. Indomethacin is related to aspirin and ibuprofen and works by
stimulating the muscles inside the PDA to constrict, thereby closing the connection. Your

child's physician can answer any further questions you may have about this treatment.
As previously mentioned, some children will have no symptoms, and require no
medications. However, others may need to take medications to help the heart and lungs
work better. Medications that may be prescribed include the following:
o digoxin : - a medicine that helps strengthen the heart muscle, enabling it to pump
more efficiently.

o diuretics : - the body's water balance can be affected when the heart is not
working as well as it could. These medications help the kidneys remove excess
fluid from the body.

adequate nutrition
Most infants with PDA eat and grow normally, but premature infants or those infants with
a large PDA may become tired when feeding, and are not able to eat enough to gain
weight. Options that can be used to ensure your baby will have adequate nutrition include
the following:
o high-calorie formula or breast milk : - Special nutritional supplements may be
added to formula or pumped breast milk that increase the number of calories in
each ounce, thereby allowing your baby to drink less and still consume enough
calories to grow properly.

o supplemental tube feedings : - Feedings given through a small, flexible tube that
passes through the nose, down the esophagus, and into the stomach, can either
supplement or take the place of bottle-feedings. Infants who can drink part of their
bottle, but not all, may be fed the remainder through the feeding tube. Infants who
are too tired to bottle-feed may receive their formula or breast milk through the
feeding tube alone.

PDA repair or closure in India

The majority of infants and children with PDA are candidates for repair in the cardiac
cath lab. The goal is to repair the PDA before the lungs become diseased from too much
blood flow and pressure.
Repair is usually indicated in infants younger than 6 months of age who have large
defects that are causing symptoms, such as poor weight gain and rapid breathing. For
infants who do not exhibit symptoms, the repair may often be delayed until after 6
months of age. Your child's cardiologist will recommend when the repair should be

performed.
Transcatheter coil closure of the PDA is frequently used because it is minimally invasive.
However, premature infants are not candidates for this procedure.
Your child's PDA may be repaired surgically in the operating room. The surgical repair,
also called PDA ligation, is performed under general anesthesia. The procedure involves
closing the open PDA with stitches to prevent the surplus blood from entering your
child's lungs. Alternately, the vessel connecting the aorta and pulmonary artery may be
cut and cauterized (sealed off by burning with an electrical instrument).

Post-procedure care for your child : -

Cath lab PDA repair/closure procedure

When the procedure is complete, the catheter(s) will be withdrawn. Several gauze pads
and a large piece of medical tape will be placed on the site where the catheter was
inserted to prevent bleeding. In some cases, a small, flat weight or sandbag may be used
to help keep pressure on the catheterization site and decrease the chance of bleeding. If
blood vessels in the leg were used, your child will be told to keep the leg straight for a
few hours after the procedure to minimize the chance of bleeding at the catheterization
site.
Your child will be taken to a unit in the hospital where he/she will be monitored by
nursing staff for several hours after the test. The length of time it takes for your child to
wake up after the procedure will depend on the type of medicine given to your child for
relaxation prior to the test, and also on your child's reaction to the medication. After the
procedure, your child's nurse will monitor the pulses and skin temperature in the leg or
arm that was used for the procedure.
Your child may be able to go home after a specified period of time, providing he/she does
not need further treatment or monitoring. You will receive written instructions regarding
care of the catheterization site, bathing, activity restrictions, and any new medications
your child may need to take at home.

Surgical repair (PDA Surgery)

Some children who undergo PDA ligation may need to spend some time in the intensive

care unit after surgery. Others may return to a regular hospital room. Your child will be
kept as comfortable as possible with medications which relieve pain or anxiety. The staff
will also be asking for your input as to how best to soothe and comfort your child.
You will also learn how to care for your child at home before your child is discharged.
The staff will give you instructions regarding medications, activity limitations, and
follow-up appointments before your child is discharged. Most children will only need to
stay in the hospital for a few days after the operation.