Is There A Surgery For Patent Ductus Arteriosus & Can A Baby Die From It?

PDA is frequently found in premature infants of all gestational ages associated with respiratory distress syndrome.3

Patent ductus arteriosus in premature infants can show resistance to pharmacologic treatment, and hence surgical intervention is required to manage the heart defect.3

Is There A Surgery For Patent Ductus Arteriosus?

A diagnosis of patent ductus arteriosus is established based on the clinical symptoms and signs followed by imaging techniques and laboratory tests. ECG helps reveal left or right ventricular hypertrophy, depending on the degree of left to right shunting. ECHO helps identify cardiomegaly, and increased pulmonary markings are most often appreciated with chest radiography. ECHO will show the size of the opening, demonstrate the shunt, and also allows in the estimation of the mean pulmonary arterial pressure. ECHO is considered the gold standard for the diagnosis of ductus arteriosus, and information provided by it becomes crucial in making an accurate diagnosis. It also rules out other ductal dependant cardiac lesions in which closure of ductus will result in rapid clinical deterioration and subsequent death of the infant.2

The main strategies to treat patent ductus arteriosus are the restriction of fluid and watchful waiting, pharmacological management, and surgical ligation. The loop diuretic furosemide is useful in cases where the neonate is showing signs of CHF while waiting or spontaneous closure of DA.

Persistent patent ductus arteriosus cases are treated with indomethacin postnatally, which has favorable outcomes in extremely low birth weight neonates. IV indomethacin and IV ibuprofen lysine are effective in the closure of PDA wit closure rates being around 75% to 93%.2

Surgical repair of the patent ductus arteriosus is done by either ligation or a combination of ligation and dividing the DA using surgical clips or non-absorbable sutures. A safe method to effectively ligate the DA with minimal invasiveness is video-assisted thoracoscopic surgery. Other patients who require open ligation are treated via left posterior lateral thoracotomy. Surgical ligation is mostly performed in infants who do not respond to pharmacologic treatment.2

Both the pharmacological treatment and surgical ligation show the same effect on closure in terms of mortality during the hospital stay. However, surgical ligation can lead to complications such as bronchopulmonary dysplasia (BDP), neurosensory impairment, and severe retinopathy of prematurity (ROP). The increased risks were usually based on analysis of patients from the Trial of Indomethacin Prophylaxis in Pre terms (TIPP) trial. Immature gestation is mostly accounted for neonatal morbidities in the assessed cases; however, surgical ligation was associated with CLD.

Other complications of surgical ligation are pneumothorax, infection, laryngeal nerve paralysis, erroneous closure of phrenic nerve, or major blood vessels other than DA and respiratory compromise.2

Can A Baby Die From Patent Ductus Arteriosus?

There have been no procedural deaths reported for patent ductus arteriosus.

The DA or ductus arteriosus is a normal blood vessel in neonates that connects two major arteries- the aorta and the pulmonary artery, which help in carrying blood away from the heart. Since the lungs in a growing fetus are nonfunctional in the womb, the baby gets oxygen via the mother’s placenta. The DA helps in carrying blood away from the lungs directly to the body, where the gaseous exchange takes place in the womb. However, after birth, when the baby starts to breathe and use its lungs, the DA is no longer required, and the ductus normally closes itself within 72 hours after birth.1

If this ductus arteriosus doesn’t close, then it results in a ‘remaining’ defect in the heart known as the patent ductus arteriosus or PDA. The PDA leads to the mixing of oxygen-rich blood from the aorta with the oxygen-poor blood from the pulmonary artery. This mixing of blood results in an excess flow of blood to the lungs leading to strain on the heart, which thereby increases blood pressure in the pulmonary arteries. In a few cases where infants are born with other heart defects that decrease the flow of blood from the heart to lungs or decrease the flow of oxygen-rich blood to the body, the patent ductus arteriosus helps in circulation. The doctor will usually prescribe medications, in this case, to keep the ductus arteriosus open.1

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