PDA Closure in South Africa

Patent ductus arteriosus (PDA) is a heart disorder first diagnosed or observed during the first few weeks or months of the surgery. This condition is characterized by the persistence of a normal fetal connection between the pulmonary artery and the aorta, which may allow the flow of some of the oxygenated blood back to the lungs instead of the body.

This connection is naturally present in the fetus during pregnancy. It is, in fact, present at the time of birth as well But it closes off on its own within a few days.

During pregnancy, all of the oxygen demand of the fetus is met through the placenta. Therefore, there is no need for the blood to go through the lungs for oxygenation. However, a connection is necessary to let oxygenated blood bypass the lungs of the fetus and reach the body. This connection is known as ductus arteriosus (DA).

As soon as the baby is born, the lungs take over the functioning of the connection and start purifying the blood. The problem arises when the connection does not close on its own within a few days after the birth. This condition is known as PDA.

The exact reason why DA remains open (patent) is some infants is still unknown. However, girls are twice as likely to suffer from PDA as boys. Additionally, PDA may occur in combination with other heart defects as well.

PDA, if left untreated, may lead to a number of complications. Because of the flow of oxygenated blood from the aorta to the pulmonary artery and the mixing of blood, the vessels of the lungs have to handle a large amount of blood. The larger the volume of blood that enters the pulmonary artery, the greater they have to cope with the increased pressure. This may lead to long-term damage to the lungs.

PDA may cause no symptoms at all in some children. However, the following are some of the symptoms experienced by a majority of children with PDA:

• Heavy, congested, or rapid breathing
• Fatigue
• Sweating
• Poor weight gain
• No interest in feeding
• Excessive tiredness while feeding

PDA closure is performed under the influence of general anaesthetic (GA) using the heart catheterization procedure. During the closure, the surgeon places a closure device into the catheter.

A typical PDA closure device is made up of mesh and metal material. It is a short tube with discs of different sizes in both its ends. The device is folder before its insertion into the catheter. The device is moved out of the catheter upon reaching the right place. One of the appropriate discs opens up when the device is moved out of the catheter. It’s acts like a plug and seals off the PDA, stopping the flow of oxygenated blood to the pulmonary artery.

The catheter is usually inserted into a blood vessel in the groin region. The catheter is gently moved up to reach the site of PDA. The closure device is threaded through to reach the PDA site and is placed in the targeted position. Once the device is in place, the catheter is withdrawn and the site of catheter insertion is bandaged.

The procedure takes anywhere from one to three hours to complete. As soon as the procedure is over, the child is transferred to the recovery room and is kept there as long as the effect of the GA fades off. Most of the children are discharged on the same day as that of PDA closure procedure. However, they will be required to stay in the hospital for at least four to six hours after the surgery.

Some children, however, will be required to stay in the hospital overnight. They are transferred to the inpatient unit after the effect of the GA is over. A chest X-ray is conducted the next day in the case of all patients to check the position of the closure device. Children who are discharged on the same day of the procedure must be brought to the hospital again in the next morning for the X-ray.

The surgeon may prescribe a few antibiotics after the surgery to prevent heart infection known as infectious endocarditis. It is common for premature infants or infants with larger PDA to become tired feeding. Therefore, care must be taken to high-calorie formula or breast milk to them for normal growth and development.