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.
In this day and age there are two different options to close a PDA. Device closure of a patent ductus arteriosus is most commonly performed in larger infants and older children. In premature babies and in neonates, as well as older infants who have large PDA's, surgery is typically necessary. Fortunately, surgery in this day and age is generally safe.
Patent Ductus Arteriosus - Surgical Ligation
Surgery to ligate or close a patent ductus arteriosus is usually performed through a left thoracotomy. This is an incision between the ribs on the back left side of the body. An approach from the back left side is typically easier than going through the front of the chest because the PDA is typically fairly posterior in the chest. Once the surgeon has isolated the patent ductus arteriosus, the PDA is typically clipped and/or divided completely.
Hospitalization for a child undergoing a PDA ligation can vary according to the child's condition initially. Premature babies undergoing a PDA ligation are often very sick and require prolonged hospitalization, often for reasons unrelated to the PDA ligation. Newborns and larger infants may require only a one night stay in the hospital.
All patients who undergo surgery for a PDA are required to take antibiotics before any dental or surgical procedures for at least 6 months following the procedure, termed SBE prophylaxis. 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.
The long-term outlook for a child undergoing a surgical PDA ligation is very good. The vast majority do well with no significant long-term problems or complications related to the surgery.