From the Guidelines
Percutaneous catheter closure is the recommended procedure for completing a Patent Ductus Arteriosus (PDA) operation in adults, due to its high success rate and minimal complications, as stated in the 2018 AHA/ACC guideline for the management of adults with congenital heart disease 1.
Procedure Overview
The procedure for completing a PDA operation involves either surgical ligation or catheter-based closure.
- Surgical ligation requires a thoracotomy, allowing the surgeon to access the ductus arteriosus, which is then tied off with sutures or closed with clips.
- The catheter-based approach is less invasive and involves inserting a catheter through a blood vessel in the groin, guiding it to the heart, and deploying a closure device to seal the PDA.
Choice of Procedure
The choice between procedures depends on the patient's age, PDA size, and anatomy, as well as the presence of other conditions that may require surgical correction.
- Percutaneous closure is generally preferred in adults due to its lower risk of complications and faster recovery time 1.
- Surgical closure may be necessary in cases where the PDA is too large for device closure or where there are other conditions that require surgical correction.
Considerations
When considering PDA closure, it is essential to assess the patient's overall health and the presence of any other conditions that may affect the outcome of the procedure.
- Invasive hemodynamic assessment may be necessary to evaluate pulmonary vasoreactivity and determine the best course of treatment 1.
- Consultation with ACHD and pulmonary hypertension providers is crucial in complex cases, such as those with elevated pulmonary pressure and net right-to-left shunting.
From the Research
Procedure for Completing a Patent Ductus Arteriosus (PDA) Operation
The procedure for completing a PDA operation involves several steps and considerations, including:
- Medical management, which may include the use of non-steroid anti-inflammatory drugs (NSAIDs) such as indomethacin or ibuprofen to promote closure of the ductus arteriosus 2, 3, 4
- Surgical ligation, which is typically considered if pharmacological treatment fails to close the PDA in symptomatic infants 4, 5
- Transcatheter device closure, which is a minimally invasive procedure that can be used to close the PDA 5
Treatment Options
The treatment options for PDA include:
- Pharmacological treatment with NSAIDs, such as indomethacin or ibuprofen, which can be effective in promoting closure of the ductus arteriosus 2, 3, 4
- Surgical ligation, which is typically considered if pharmacological treatment fails to close the PDA in symptomatic infants 4, 5
- Transcatheter device closure, which is a minimally invasive procedure that can be used to close the PDA 5
- Acetaminophen, which has been suggested as a promising new alternative to indomethacin and ibuprofen for closure of PDA with potentially fewer adverse effects 6
Considerations
The choice of treatment for PDA depends on several factors, including: