Patent ductus arteriosus surgery: Difference between revisions
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'''Silent PDA''' | '''Silent PDA''' | ||
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* Detected incidentally on diagnostic procedures done for other conditions. | * Detected incidentally on diagnostic procedures done for other conditions. | ||
* Some experts are of opinion that silent PDA should be closed to decrease the risk of future endocarditis. Others believe that since silent PDA have very less risk for causing any hemodynamic complications in future so it could be left without any surgical intervention. | * Some experts are of opinion that silent PDA should be closed to decrease the risk of future endocarditis. Others believe that since silent PDA have very less risk for causing any hemodynamic complications in future so it could be left without any surgical intervention. | ||
THERAPEUTIC INTERVENTIONS — Interventions for PDA clos | THERAPEUTIC INTERVENTIONS — Interventions for PDA clos | ||
Infants without adverse symptoms may simply be monitored as [[outpatient]]s, while symptomatic PDA can be treated with both [[surgery|surgical]] and non-surgical methods.<ref>Zahaka, KG and Patel, CR. "Congenital defects.'" Fanaroff, AA and Martin, RJ (eds.). ''Neonatal-perinatal medicine: Diseases of the fetus and infant.'' 7th ed. (2002):1120-1139. St. Louis: Mosby.</ref> Surgically, the DA may be closed by ligation, wherein the DA is manually tied shut, or with intravascular coils or plugs that leads to formation of a thrombus in the DA. Fluid restriction and [[prostaglandin]] inhibitors such as [[indomethacin]] have also been used in successful non-surgical closure of the DA. This is an especially viable alternative for premature infants. If [[indomethacin]] fails or if a child is more than 6 to 8 months old, '''surgical ligation''' of the PDA can be accomplished with excellents results in uncomplicated patients. Recent experience with '''transcatheter closure''' has also been favorable, being today the procedure of choice for most patients. | Infants without adverse symptoms may simply be monitored as [[outpatient]]s, while symptomatic PDA can be treated with both [[surgery|surgical]] and non-surgical methods.<ref>Zahaka, KG and Patel, CR. "Congenital defects.'" Fanaroff, AA and Martin, RJ (eds.). ''Neonatal-perinatal medicine: Diseases of the fetus and infant.'' 7th ed. (2002):1120-1139. St. Louis: Mosby.</ref> Surgically, the DA may be closed by ligation, wherein the DA is manually tied shut, or with intravascular coils or plugs that leads to formation of a thrombus in the DA. Fluid restriction and [[prostaglandin]] inhibitors such as [[indomethacin]] have also been used in successful non-surgical closure of the DA. This is an especially viable alternative for premature infants. If [[indomethacin]] fails or if a child is more than 6 to 8 months old, '''surgical ligation''' of the PDA can be accomplished with excellents results in uncomplicated patients. Recent experience with '''transcatheter closure''' has also been favorable, being today the procedure of choice for most patients. | ||
Revision as of 13:57, 20 July 2011
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Patent Ductus Arteriosus Microchapters |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Associate Editor-In-Chief:Cafer Zorkun, M.D., Ph.D. [2]; Keri Shafer, M.D. [3] Priyamvada Singh, MBBS [[4]]
Assistant Editor-In-Chief: Kristin Feeney, B.S. [[5]]
Surgery
Indications for Surgery
- Symptomatic patients with left to right shunt (left sided volume overload).
- Reversible pulmonary arterial hypertension.
Contraindication
- Severe and irreversible pulmonary artery hypertension
- Eisenmenger's syndrome.
There is some lack on consensus on the management strategies of silent and small patent ductus arteriosus.
Small PDA
Small PDA may present with audible murmur with or without symptoms of left volume overload. The American College of Cardiology/American Heart Association (ACC/AHA)recommends closure of small PDA, even without evident left sided volume overload. In case the PDA is left untreated, a follow-up every 3-5 year is recommended.
Silent PDA
Silent PDA
- No audible murmur.
- Detected incidentally on diagnostic procedures done for other conditions.
- Some experts are of opinion that silent PDA should be closed to decrease the risk of future endocarditis. Others believe that since silent PDA have very less risk for causing any hemodynamic complications in future so it could be left without any surgical intervention.
THERAPEUTIC INTERVENTIONS — Interventions for PDA clos
Infants without adverse symptoms may simply be monitored as outpatients, while symptomatic PDA can be treated with both surgical and non-surgical methods.[1] Surgically, the DA may be closed by ligation, wherein the DA is manually tied shut, or with intravascular coils or plugs that leads to formation of a thrombus in the DA. Fluid restriction and prostaglandin inhibitors such as indomethacin have also been used in successful non-surgical closure of the DA. This is an especially viable alternative for premature infants. If indomethacin fails or if a child is more than 6 to 8 months old, surgical ligation of the PDA can be accomplished with excellents results in uncomplicated patients. Recent experience with transcatheter closure has also been favorable, being today the procedure of choice for most patients.
In certain cases it may be beneficial to the newborn to prevent closure of the ductus arteriosus. For example, in transposition of the great vessels a PDA may prolong the child's life until surgical correction is possible. The ductus arteriosus can be induced to remain open by administering prostaglandin analogs.
Small and medium-sized ductus
Three risks exist:
- Endocarditis
- Deposition of calcium in the walls of the ductus which can compromise surgical results
- Heart failure with a medium-sized ductus.
Because of these risks, the mere presence of a ductus in childhood is an indication for operation at age 1 to 2 years.
Large PDAs with severe pulmonary vascular obstructive disease
If the pulmonary vascular resistance is > 10 units/m2 then this contraindicates closure. The risk of death from repair at all ages is < 2%, and is under 1% when patients with pulmonary hypertension and small infants are excluded. LVH regresses, but if there is pulmonary hypertension, RVH does not regress. The risk of endocarditis disappears. The lesion can also be closed using a Rashkind device. There is a 15% risk of embolization of the occluder in a multicenter report of 156 patients.
References
- ↑ Zahaka, KG and Patel, CR. "Congenital defects.'" Fanaroff, AA and Martin, RJ (eds.). Neonatal-perinatal medicine: Diseases of the fetus and infant. 7th ed. (2002):1120-1139. St. Louis: Mosby.