How Is Patent Ductus Arteriosus Treated?

Patent ductus arteriosus (PDA) is treated with medicines, catheter-based procedures, and surgery. The goal of treatment is to close the PDA. Closure will help 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 PDA is large or causing health problems. For premature infants, treatment is needed if the PDA is causing breathing problems or heart problems.

Talk with your child's doctor about treatment options and how your family prefers to handle treatment decisions.

Medicines

Your child's doctor may prescribe medicines to help close your child's PDA.

Indomethacin (in-doh-METH-ah-sin) is a medicine that helps close PDAs in premature infants. This medicine triggers the PDA to constrict or tighten, which closes the opening. Indomethacin usually doesn't work in full-term infants.

Ibuprofen also is used to close PDAs in premature infants. This medicine is similar to indomethacin.

Catheter-Based Procedures

Catheters are thin, flexible tubes that doctors use as part of a procedure called cardiac catheterization (KATH-eh-ter-ih-ZA-shun). Catheter-based procedures often are 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 sometimes is used for small PDAs to prevent the risk of infective endocarditis (IE). IE is an infection of the inner lining of the heart chambers and valves.

Your child will be given medicine to help him or her relax or sleep during the procedure. The doctor will insert a catheter in a large blood vessel in the groin (upper thigh). He or she will then guide the catheter to your child's heart.

A small metal coil or other blocking device is passed through the catheter and placed in the PDA. This device blocks blood flow through the vessel.

Catheter-based procedures don't require the child's chest to be opened. They also allow the child to recover quickly.

These procedures often are done on an outpatient basis. You'll most likely be able to take your child home the same day the procedure is done.

Complications from 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 to correct a PDA may be done if:

• A premature or full-term infant has health problems due to a PDA and is too small to have a catheter-based procedure
• A catheter-based procedure doesn't successfully close the PDA
• Surgery is planned for treatment of related congenital heart defects

Often, surgery isn't done until after 6 months of age in infants who don't have health problems from their PDAs. Doctors sometimes do surgery on small PDAs to prevent the risk of IE.

For the surgery, your child will be given medicine so that he or she will sleep and not feel any pain. The surgeon will make a small incision (cut) between your child's ribs to reach the PDA. He or she will close the PDA using stitches or clips.

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

After Surgery

After surgery, your child will spend a few days in the hospital. He or she will be given medicine to reduce pain and anxiety. Most children go home 2 days after surgery. Premature infants usually have to stay in the hospital longer because of their other health issues.

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. However, you child may have some short-term pain.

Your child should begin to eat better and gain weight quickly. Within a few weeks, he or she should fully recover and be able to take part in normal activities.

Long-term complications from surgery are rare. However, they can include narrowing of the aorta, incomplete closure of the PDA, and reopening of the PDA.

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