Patent ductus arteriosus surgery


 * Associate Editor-In-Chief: Priyamvada Singh, M.B.B.S. [mailto:psingh@perfuse.org], ; Assistant Editor-In-Chief: Kristin Feeney, B.S. [mailto:kfeeney@perfuse.org]

Overview
Infants without overt symptoms may simply be monitored as outpatients, while symptomatic PDA can be treated with both surgical and non-surgical methods. . Surgically, the ductus arteriosus may be closed by ligation, wherein the DA is manually tied shut, or with intravascular coils or plugs that leads to formation of a thrombus in the duct. Surgical ligation of the PDA can be accomplished with excellent results in uncomplicated patients. Recent experience with transcatheter closure has also been favorable, being today the procedure of choice for most patients. In certain cases it may be beneficial to the newborn to prevent closure of the ductus arteriosus. For example, in transposition of the great vessels a PDA may prolong the child's life until surgical correction is possible. The ductus arteriosus can be induced to remain open by administering prostaglandin analogs.

Surgical options
The decision about the operative technique used depends on size of duct (left to right shunt) and age and weight of the patient.
 * Ligation
 * Percutaneous occlusion (Coils, occlusive devices)
 * Surgical closure by thoracotomy or sternotomy is indicated in cases where device and coil closures are not possible. These are in conditions like large ductus, infections and aneurysm.

Video-assisted thoracoscopic surgical ligation

The PDA is ligated with the help of a surgical clip via posterolateral thoracotomy approach. .

Advantages-


 * Less invasive than thoractomy.
 * Safe and effective

Percutaneous occlusion

Percutaneous occlusion is the treatment of choice in the majority of adult patients. It is achieved by two ways-


 * Coils - Coils give better results with small ducts compared to large.


 * Occlusion devices - 'Amplatzer ductal occluder'(ADO)

Advantages


 * It has been found to be successful in moderate and large PDA.
 * Patients beyond the neonatal period have better post operative prognosis by this device.
 * Gives good results with conical ductus (narrowest segment located at the PA end)
 * It can adapt to a variety of ductal sizes and shapes.

Surgical closure by thoracotomy or sternotomy


 * Indicated in cases where device and coil closures are not possible.
 * In conditions with large ductus, infections and aneurysm.