Indications for surgery in patent ductus arteriosus


 * 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
The decision to operate a patent ductus arteriosus should be made based on the risk to benefits ratio ==Indications for Surgery ==


 * Symptomatic patients with left to right shunt (left sided volume overload).
 * Reversible pulmonary arterial hypertension.
 * If medical therapy fails (fluid restriction and prostaglandin inhibitors such as indomethacin)
 * If a child is more than 6 to 8 months old, surgical correction of PDA is warranted.

There is some lack on consensus on the management strategies of silent and small patent ductus arteriosus.

Small PDA
 * Small PDA may present with audible murmur with or without symptoms of left volume overload. The American College of Cardiology/American Heart Association (ACC/AHA)recommends closure of small PDA, even without evident left sided volume overload. In case the PDA is left untreated, a follow-up every 3-5 year is recommended.

Silent PDA
 * No audible murmur.
 * Detected incidentally on diagnostic procedures done for other conditions.
 * Some experts are of opinion that silent PDA should be closed to decrease the risk of future endocarditis. Others believe that since silent PDA have very less risk for causing any hemodynamic complications in future so it could be left without any surgical intervention.