How Is Patent Ductus Arteriosus Treated?

Patent ductus arteriosus (PDA) is treated with medicines, catheter-based procedures, and surgery. The goal of treatment is to close the PDA to prevent complications and reverse the effects of increased blood volume.

Small PDAs often close without treatment. For full-term infants, treatment is needed if the child's PDA is large or causing health problems.

For premature infants, treatment is needed if the PDA is causing breathing problems or heart problems.

Talk to your child's doctor about treatment options and your family's preferences on treatment decisions.

Medicines

Your child's doctor may prescribe medicines to help close your child's PDA.

Indomethacin is a medicine that helps close PDAs in premature infants. This medicine works by stimulating the PDA to constrict or tighten, closing the opening. Indomethacin usually doesn't work in full-term infants.

Ibuprofen is a medicine in the same family as indomethacin. It's also frequently used to close PDAs in premature infants.

Catheter-Based Procedures

Catheters are thin, flexible tubes used in a procedure called cardiac catheterization (KATH-e-ter-i-ZA-shun). Catheter-based procedures often are used to close PDAs in infants or children who are large enough to have the procedure.

Your child's doctor may refer to the procedure as "transcatheter device closure." The procedure sometimes is done on small PDAs to prevent the risk of infective endocarditis (IE), an infection of the lining of the heart, valves, or arteries.

During the procedure, your child will be sedated or given medicine so that he or she will sleep and not feel any discomfort. The doctor will place a catheter in a large blood vessel in the upper thigh (groin) and guide it to your child's heart.

A small metal coil or other blocking device is then passed up through the catheter and placed in the PDA to block blood flow through the vessel.

Catheter-based procedures don't require the child's chest to be opened. They also let the child recover quickly.

Closing a PDA using a catheter often is done on an outpatient basis. You'll most likely be able to take your child home the same day the procedure is done.

Complications from catheter-based procedures are rare and short term. They can include bleeding, infection, and movement of the blocking device from where it was placed.

Surgery

Surgery for PDA may be done if:

• A premature or full-term infant develops health problems from the PDA and is too small to have a catheter-based procedure
• A PDA isn't successfully closed by a catheter-based procedure
• Surgery is planned for treatment of related congenital heart defects

Often, surgery isn't done until after 6 months of age in infants who don't have health problems from their PDAs. Doctors sometime perform surgery on small PDAs to prevent the risk of IE.

For the surgery, your child will be given medicine so that he or she will sleep and not feel any discomfort. The surgeon will make a small cut between your child's ribs to reach the PDA. He or she will then close the PDA with stitches or clips.

Complications from surgery are rare and usually short term. They can include hoarseness, a paralyzed diaphragm (the muscle below the lungs), infection, bleeding, or fluid buildup around the lungs.

After Surgery

After surgery, your child will spend a few days in the hospital. He or she will be given medicines to reduce pain and anxiety. Most children go home 2 days after surgery. Premature infants usually have to stay in the hospital longer because of their other health issues.

The doctors and nurses at the hospital will teach you how to care for your child at home. They will talk to you about:

• Limits on activity for your child while he or she recovers
• Followup appointments with your child's doctors
• How to give your child medicines at home, if needed

When your child goes home after surgery, you can expect that he or she will feel fairly comfortable, although there may be some short-term pain.

Your child should begin to eat better and gain weight quickly. Within a few weeks, he or she should fully recover and be able to take part in normal activities.

Long-term complications from surgery are rare. However, they can include narrowing of the aorta, incomplete closure of the PDA, and reopening of the PDA.