How Is PDA Surgery Performed?

The PDA closure procedure may take up to three hours, depending on the type of procedure. It may take longer if the PDA closure is accompanied by other procedures to correct any additional heart defects.

PDA stands for “patent ductus arteriosis,” which is a congenital failure of the heart to develop properly, leaving an opening between chambers that hinders blood flow. 

The patient is under general anesthesia for all types of PDA closure procedures. 

In the case of full-term and premature newborns, the procedure may be performed in the neonatal ICU. 

For other children and adults, surgical closure is performed in the operation room. A catheter closure is performed in a cardiac catheterization laboratory.

Preparation

Prior to the procedure, a child patient

• Undergoes blood tests
• Cardiac radiography tests such as
  • echocardiography
  • electrocardiography
• Is hydrated in case of a catheter approach, to ensure that the dye used for continuous X-ray (fluoroscopy) does not cause kidney problems
• An adult patient is required to
• Undergo blood and cardiac radiography tests
• Avoid eating or drinking for eight hours prior to the procedure
• Inform the doctor of any allergies
• Inform the doctor if pregnant
• Check with the doctor before taking any regular medications

Procedure

• The anesthesiologist administers anesthesia through an IV line and monitors the patient’s vital signs.
• The patient is connected to an electrocardiogram to monitor the heart’s electrical impulse.
• In a surgical PDA closure, the surgeon
  • Makes one or more incisions on the chest, depending on the type of surgery.
  • Accesses the thoracic cavity through the third or fourth between the ribs (intercostal space space).
  • Places ligation on both ends of the ductus arteriosus, severs it in the middle, and closes the severed ends with sutures.
  • Alternately, may use a metal clamp to close the ductus.
  • May apply a patch to close if the PDA is large.
  • Places a chest tube for drainage and closes the incisions with sutures.
• In a catheter PDA closure, the doctor
  • inserts a catheter into the femoral vein and advances it into the heart and ductus arteriosus.
  • Uses ultrasound imaging and fluoroscopy to guide the process.
  • Blocks the ductus with a plug or coil-like metallic device inserted through the catheter.
  • Gently withdraws the catheter back out of the vein.
  • Closes the puncture site in the groin with a bandage.

Post-procedure

• The patient’s vital functions are monitored for several hours.
• The chest tube will normally be removed the next day.
• In case of catheter closure, the patient can usually leave the hospital the next day.
• Surgical closure may require hospitalization for up to five days.
• Full recovery may take up to eight weeks.
• Patients will require regular monitoring after the procedure.

PDA closure procedure has good long-term results, especially if there is no other congenital heart defect. Risks of anesthesia and surgery are higher in newborn infants.

The complications include the following:

Anesthetic side effects

Adults and adolescents:

• Headache
• Nausea
• Confusion

Children:

• Nausea
• Vomiting
• Itchiness
• Delirium while waking from anesthesia (emergence delirium)
• Agitation and anxiety
• Night terrors

Surgical risks such as

• Ligation of the aorta or pulmonary artery
• Hemorrhage
• Wound infection
• Pneumonia
• Sepsis
• Death
• Injury to
  • Thoracic nerves
  • Thoracic lymphatic duct
  • Blood vessels
  • Heart
  • Lungs
• Incomplete closure of PDA
• Vocal cord paralysis due to nerve injury

Catheter closure

• Bleeding at the puncture site in the femoral vein
• Rupture of blood vessels
• Irregular heartbeat (arrhythmia)
• Blockage in blood vessels
• Improper placement of the device
• Dislodgement of the device
• Incomplete closure of the ductus