Patent ductus arteriosus (PDA) is a common congenital heart disease. Every baby is born with a ductus arteriosus. After birth, the opening is no longer needed and it usually narrows and closes within the first few days of life. Failure to do so results in Patent Ductus Arteriosus (PDA) which allows blood to flow from the aorta to the pulmonary artery.
If the PDA is large, the heart will be volume loaded resulting in heart failure. The PDA also carries a risk of bacterial infection (Endocarditis) and pulmonary hypertension.
Cause of Patent Ductus Arteriosis (PDA)
The exact cause of patent ductus arteriosus isn't known, could be a genetic defect. PDA is more commonly seen in:
- Premature infants
- Infants who have genetic conditions such as Down syndrome
- Infants whose mothers had rubella during pregnancy
- PDA is twice as common in girls as it is in boys
Indication for PDA closure
- The presence of volume overloading of the left atrium and left ventricle
- Risks of endocarditis
- Risk of Pulmonary hypertension
- Aneurysm of PDA
Signs and Symptoms
Depends on size of PDA:
- If PDA is small, a specific Heart murmur also called machinery murmur may be the only sign of patent ductus arteriosus (PDA).
- If Large PDA, apart from the murmur, some may develop signs or symptoms
- Poor feeding and poor weight gain
- Easily tired
- Easy Sweating like with feeding
- Echocardiography (echo) Echo is the most important test available to both diagnose a heart problem and follow the problem over time.
- Doppler study
Treatment of PDA Device Closure
- Regular monitoring and Medications,
- Transcatheter closure of PDA using the occluder device has been shown to be safe and efficacious.
- Medical history noted and clinical examination of the child performed
- Adviced general tests to check for fitness of surgery
- Counselled regarding the procedure
- Procedure usually takes about 1 to 3 hours.
- Usually performed in cardiac catherization lab.
- Access in the femoral vein is obtained with placement of a sheath. A sheath is placed in the femoral artery.
- The device is then advanced to the tip of the sheath in the descending aorta The sheath and device are then pulled back into a position.
- When good position is achieved, the sheath is retracted further and the tubular part of the device is opened within the PDA.
- Angiogram is performed in the descending aorta to confirm final device position up to this step, the device can be repositioned or retrieved if the angiogram showed significant residual flow.
- Occasionally a repeat angiogram is performed in the descending aorta ten minutes after.
- If device position is satisfactory, the device is released.
- The patient is hospitalized for a day to monitor the vitals.
- An X-ray and echo doppler study performed the next day after the procedure to make sure the closure device has not moved.
- Usually discharged after evaluationand kept on oral antibiotic.
- Subacute bacterial endocarditis prophylaxis is recommended for six months or until complete closure is obtained.
- Cardiologist may advise some physical activity restrictions for a short time.
- Pregnancy is low risk in patients with PDAunless there is pulmonary hypertension or signs of heart failure.
- Follow-up the patient includes clinical evaluation, transthoracic echocardiography and CXR done at regular intervals.
Though rare, may include:
- Infection, and
- Displacement of the blocking device from where it was placed
- Transient arrhythmia
- Allergic reaction to the device
- Clot formation
Prognosis of PDA Device Closure
PDA closure procedure has about 95% success rate. The long-term outlook is good and usually, no medicines and no additional surgery or catheterization are needed.
Factors Affecting the Cost of PDA Device Closure
Following are the factors which will affect the treatment cost:
- The hospital patient is opting for
- Operating room, recovery room charges
- Fee for the team of doctors (Cardiologists, Anesthesist etc)
- Medicines and sterile dressings
- Standard test and diagnostic procedures
- Cost of Device
- Cost of follow up care