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 12 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. |