How Is Patent Ductus Arteriosus Treated?

The goal of treatment is to close the patent ductus arteriosus (PDA) to prevent complications and reverse the effects of increased blood volume.

Small PDAs often close without treatment. For full-term infants, treatment is needed if the child's PDA:

• Is large
• Is causing the child to have health problems
• Does not close on its own by the time the child is 1–2 years old

For premature infants (babies born too early), treatment is needed if the PDA is causing increased respiratory distress and heart problems.

Specific Types of Treatment

Treatments for PDA include:

• Medicines
• Catheter-based procedures
• Surgery

Your child's doctor will discuss the treatment options and your family's preferences regarding treatment decisions.

Medicines

Medicines can be given to help close a PDA.

• Indomethacin (in-doh-METH-ah-sin) is a drug that helps close a PDA in premature infants. It does not usually work in full-term infants. It works by stimulating the PDA to constrict or tighten, closing the connection.
• Ibuprofen (EYE-boo-pro-fen) is a medicine in the same family as indomethacin. It is also used frequently to close a PDA in premature infants.

If a PDA is small and the decision is made not to treat it right away, antibiotics may be prescribed to prevent endocarditis.

Catheter-based procedures

Catheters are thin, flexible tubes used in a procedure called cardiac catheterization (KATH-e-ter-i-ZA-shun). Catheter-based procedures are often used to close PDAs in infants or children who are large enough to have the procedure. Your child's doctor may refer to the procedure as "transcatheter device closure." The procedure is sometimes done on small PDAs to prevent the risk of bacterial endocarditis.

During the procedure, your child will be sedated or given general anesthesia so he or she will sleep and not feel any discomfort. The doctor will place a catheter in a large blood vessel in the upper thigh (groin) and guide it to your child's heart.

A small metal coil or other blocking device is passed up through the catheter and placed in the ductus arteriosus to block blood flow through the vessel.

Catheter-based procedures:

• Do not require the child's chest to be opened
• Let the child recover quickly

Closing a PDA using a catheter is often done on an outpatient basis. You will most likely be able to take your child home the same day the procedure is done.

Complications of catheter-based procedures are rare and short term. They can include bleeding, infection, and movement of the blocking device from where it was placed.

Surgery

Surgery for PDA may be performed when:

• A premature or full-term infant develops health problems from the PDA and is too small to have a catheter-based procedure
• A PDA is not successfully closed by a catheter-based procedure
• Surgery is planned for treatment of related congenital heart defects

Surgery often is not performed until after 6 months of age in infants who do not have health problems from the PDA. Doctors sometime perform surgery on small PDAs to prevent the risk of bacterial endocarditis.

The operation is done under general anesthesia so that your child will sleep and not feel any pain. The surgeon will:

• Make a small cut between your child's ribs to reach the PDA
• Close the PDA with stitches or clips

Complications of the surgery are rare and usually short term. They can include hoarseness, a paralyzed diaphragm, infection, bleeding, or fluid buildup around the lungs.

After surgery. After surgery, your child will spend a few days in the hospital. Most children go home 2 days after surgery. While in the hospital, your child will be given medicines to reduce pain or anxiety. The doctors and nurses at the hospital will teach you how to care for your child at home. They will talk to you about:

• Limits on activity for your child while he or she recovers
• Followup appointments with your child's doctors
• How to give your child medicines at home, if needed

When your child goes home after surgery, you can expect that he or she will feel fairly comfortable, although there may be some pain temporarily.

Your child should begin to eat better and gain weight quickly. Within a few weeks, your child should be fully recovered and able to participate in normal activities.

Long-term complications from surgical treatment are rare. They can include narrowing of the aorta, incomplete closure of the ductus arteriosus, and reopening of the ductus arteriosus.