Procedure for PDA Device Closure

PDA Device Closure

PDA closure device is used to surgically correct a birth defect in the heart, called patent ductus arteriosus (PDA).

PDA is the commonest congenital heart disease (5-10%).

Risk Factors for Congenital Heart Disease

Given below are some of the causative factors of the Congenital Heart Disease.

1. Genetic causes: Such as CHAR syndrome. Char syndrome affects the facial, cardiac and limb development; it is usually characterized by the following signs:
• Distinctive facial appearance
• Heart defect known as patent ductus arteriosus
• Abnormalities of the hand
2. Preterm birth.
3. Chromosomal abnormality: Down syndrome.
4. Maternal infections like Rubella.
5. Maternal factors – Alcoholism.
6. Low oxygen levels.

PDA Symptoms and Definition

In the womb the foetal blood circulation bypasses the lungs. To facilitate this there is direct communication between the two major blood vessels of the heart. Eventually after birth this communication closes, but if it remains open the condition is called as patent ductus arteriosus. This causes direct mixing of the oxygenated and deoxygenated blood.

PDA can lead to medical conditions of the heart which can be life threatening:

1. Pulmonary hypertension (high blood pressure in the lungs).
2. Congestive heart disease.
3. Infection of the heart’s inner lining, called as infective endocarditis.
4. Abnormal rate and rhythm of the heart – arrhythmia.

Symptoms of PDA include the following:

1. The patient may be asymptomatic till adulthood.
2. During infancy if the defect is large the symptoms are:
• Poor growth with poor appetite.
• Easily tired.
• Sweats profusely and cries while eating.
• Increased heart rate.
3. In older children parents have to seek medical advice when the child becomes breathless while eating, feels tired all the time and is not gaining weight.

Patent Ductus Arteriosus Surgery

PDA closure surgery is done if the duct does not close after a watchful period and is causing symptoms of discomfort.

The procedure is done using a cardiac catheter:

• Under sedation and general anesthesia the catheter is threaded till the aorta (big vessel from the heart) from the blood vessel in the groin.
• The duct is closed using PDA closure devices such as a coil/mesh for smaller ductus, but for larger holes, plug shaped devices called as duct occluders are used.

Post surgery the patient is given prophylactic antibiotics and discharged after a day.

Note:

• For catheterization procedure the child should be at least 6 months old (=5kg).
• Open heart surgery is also referred to as a heart murmur treatment. This is done in heart failure in an infant less than 6 months old are present along with murmur.

PDA Surgery Success Rate

• Success rate increases with age of the patient.
• In catheterization procedure the success rate is 90-95%.
• Failure to deploy the device properly or its migration can occur rarely.