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About The Procedure

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PDA Device Closure Procedure

The ductus arteriosus is present in all foetuses enabling blood to bypass the non-working lungs. During childbirth or not long after birth as the infant inhales, the Ductus Arteriosus would usually close permanently. Inability to do so outcomes in Patent Ductus Arteriosus (PDA) which is an open channel enabling blood to flow out of the aorta (vein carrying blood from the heart to the entire body) to the pulmonary artery (vein supplying the lung).

If the PDA is large, the heart may fail. The PDA likewise conveys a risk of an infectious disease (Infective Endarteritis). PDA can be closed by inserting a device through the veins in the groin (percutaneous transcatheter approach).

Who Qualifies for PDA Device Closure?

Adults with PDA, heart enlargement or elevated pressure in the lung (considering that pressure isn't irreversibly raised) should be offered closure. In adults, device rather than coils are used as the deformity usually is greater than 4mm in size. If lung pressure is high, careful measurement of the lung pressure and lung resistance should be performed first to decide whether it is safe to close such a defect.

How is the Procedure Conducted?

This procedure is performed in the cardiovascular catheterisation lab. The doctor uses local anaesthesia or soporific (LA). The patient will lie on an x-ray table, and an x-ray camera will move over the patient's chest amid the technique. A plastic catheter (a long tube) will be embedded through a vein in the crotch and guided towards the heart. At times (contingent upon singular case), the catheter is position at different chambers of the heart to measure the pressure and oxygen content before the device closure. In specific conditions, expand estimating of the PDA might be required. Once your specialist is satisfied with all the estimations, a device of appropriate size is connected to a cable, put into a special delivery tube, and is progressed through the patient's patent ductus arteriosus (PDA) and carefully deployed. The specialist will consider the device's position and steadiness before releasing the gadget. The catheter will be removed, and the procedure is concluded.

What Risks and Complications May Arise After PDA Device Closure?

The procedure is usually completed between 1 to 2 hours, and the success rate is about 95%. The risks and their estimated incidence of occurrence are:

  • Rhythm disturbance (arrhythmia) is usually transient.
  • Device may distort blood flow in the pulmonary artery.
  • Allergic reaction to dye.
  • Allergic reaction to anaesthesia.
  • Bleeding and bruising around the sheaths in the groin.
  • Injury to the artery/vein/nerves in the groin.
  • Infection, fever, headache or migraine.
  • Allergic reaction to the nickel component of the device.
  • Device dislodgement (embolisation) and the need for emergency heart surgery.
  • Death (usually from perforation of the heart chamber).
  • Dislodgement of clot or air bubbles to the brain (causing stroke) and other organs.

Some of these complications are of a serious nature and may require further treatment including surgery and prolonged hospitalisation. In case the device is dislodged, the patient may require surgery for removal of the device and ligation of the PDA at the same time. As PDA device is relatively new, long-term follow-up, not much data is available to determine the outlook.

Follow-up and Prognosis of the Device Closure

The patient may be required to visit pediatric cardiologist get a check-up for to look underlying risks or complications. The visits are done until the heart specialist gives a green signal. Medicines are given to prevent the formation of blood clots. Devices like electrocardiograms, Holter monitors, exercise stress tests and echocardiograms are used during the follow-up to monitor the healing. The long-term outlook is excellent, and usually no medicines, additional surgery or catheterisation are required.

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Hospitals

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