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The vast majority of patients who undergo device closure of a PDA spend one night in the hospital and are discharged home the following day. They are usually back to full activity within the week. The long-term prognosis for a patient undergoing PDA closure either by surgery or device closure is outstanding.
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Read More »A patent ductus arteriosus (PDA) is an abnormal communication between the aorta and pulmonary artery that allows for oxygenated (red) blood to pass into the lungs. If the amount of blood flowing through the PDA is enough to cause problems, then intervention may be indicated. This most commonly occurs in the setting of a large or moderate size PDA. Indications for intervention in infancy include symptoms unresponsive to medication, elevated blood pressure in the lungs, and significant dilation of the heart due to excess blood flow. Usually the need for intervention in infancy becomes clear by 6-12 months of age, and often much earlier In premature and small babies typically surgery is used to close a PDA. The surgery is performed through a thoracotomy. The chest is entered from the upper left side of the back. The surgeon separates the ribs and moves the lung out of the way, allowing for visualization of the PDA. The surgeon then typically either clips or ligates the PDA. Usually this is a fairly straightforward surgery. The vast majority of babies who undergo surgery recover quickly with no significant complications. The most common form of intervention for older infants and children is “device closure” in the cardiac catheterization laboratory, as shown in the diagram above. A catheter (a long thin tube) is placed into the heart through a blood vessel in the leg. A device is then positioned in the PDA, effectively closing it from the inside. Usually scar tissue starts to form around the device very quickly, often within hours, to seal it into place permanently. Once the device is adequately positioned, there is little to no risk of it coming free. The vast majority of patients who undergo device closure of a PDA spend one night in the hospital and are discharged home the following day. They are usually back to full activity within the week. The long-term prognosis for a patient undergoing PDA closure either by surgery or device closure is outstanding. The vast majority of patients have no significant problems whatsoever long-term. All patients who undergo either surgery or device closure of a PDA are required to take antibiotics before any dental or surgical procedures for at least 6 months following the procedure. This precaution is designed to minimize the risk of any bacterial infection forming in the heart tissue. This can happen with dental work and certain forms of surgery. After 6 months, usually the normal heart tissue has sealed things in place sufficiently to no longer require this.
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Read More »Sometimes, a PDA may close on its own. In premature babies, it often closes within the first 2 years of life. In full-term infants, a PDA that remains open after the first several weeks rarely closes on its own.
If there are no other heart defects present, often the goal of treatment is to close the PDA. However, if the baby has certain other heart problems or defects, keeping the ductus arteriosus open may be lifesaving. Medicine may be used to stop it from closing. Sometimes, a PDA may close on its own. In premature babies, it often closes within the first 2 years of life. In full-term infants, a PDA that remains open after the first several weeks rarely closes on its own. When treatment is needed, medicines such as indomethacin or ibuprofen are often the first choice. Medicines can work very well for some newborns, with few side effects. The earlier treatment is given, the more likely it is to succeed. A medication called prostaglandin E1 may be used to keep the PDA open if necessary until other defects are treated. If these measures do not work or can't be used, the baby may need to have a medical procedure. A transcatheter device closure is a procedure that uses a thin, hollow tube placed into a blood vessel. The doctor passes a small metal coil or other blocking device through the catheter to the site of the PDA. This blocks blood flow through the vessel. These coils can help the baby avoid surgery. Surgery may be needed if the catheter procedure does not work or it cannot be used due to the baby's size or other reasons. Surgery involves making a small cut between the ribs to repair the PDA.
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