Background Information:

What are the other Names for the Procedure?

• Closure of Ductus Arteriosus
• Patent Ductus Arteriosus Closure
• PDA Closure

What is Ductus Arteriosus Closure surgical procedure?

• Ductus Arteriosus Closure procedure involves surgically closing the ductus arteriosus, which is a blood vessel that connects the aorta and pulmonary artery
• The blood vessel is an important part of a baby’s circulatory system before birth. It normally closes within a few hours to a few days of the child being born

What part of the Body does the Procedure involve?

Ductus Arteriosus Closure procedure involves the ductus arteriosus, aorta, and pulmonary artery.

Why is the Ductus Arteriosus Closure surgical procedure Performed?

• Ductus Arteriosus Closure procedure is performed to close the ductus arteriosus, which should have closed on its own within 12-24 hours of child’s birth
• If a surgery is not performed, it could cause several problems leading to pulmonary hypertension, heart failure; in some cases the child may even need a heart transplant surgery

What are some Alternative Choices for the Procedure?

• In a premature baby the physician may prescribe non-steroidal anti-inflammatory drugs to aid in normal closing of the ductus arteriosus. However, if the duct does not close, then a surgery is performed
• Full-term babies and adults also need to undergo an open heart surgery to treat the condition
• In some cases, a catheter-based procedure may be performed.

What are the Recent Advances in the Procedure?

The recent advances in the procedure are the use of minimally invasive procedures like catheterization.

What is the Cost of performing the Ductus Arteriosus Closure surgical procedure?

The cost of Ductus Arteriosus Closure procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient’s family to feel uncomfortable and confused with a sudden inflow of information regarding procedure and what needs to be done
• If the patient’s family needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
• Also, if the procedure involves multiple surgeries or has many alternatives, the patient’s family may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

http://www.mayoclinic.com/health/patent-ductus-arteriosus/DS00631/DSECTION=risk-factors (Accessed on 8th August, 2012)

http://www.aboutkidshealth.ca/En/ResourceCentres/PrematureBabies/UnderstandingDiagnosis/DiagnosisofHeartConditions/Pages/Diagnosis-of-Patent-Ductus-Arteriosus-PDA.aspx (Accessed on 8th August, 2012)

http://www.nhlbi.nih.gov/health/health-topics/topics/pda/atrisk.html (Accessed on 8th August, 2012)

Prior to Ductus Arteriosus Closure surgical procedure:

How is the Ductus Arteriosus Closure surgical procedure Performed?

• During Ductus Arteriosus Closure surgical procedure, an incision is made in the chest and the skin, tissue, and muscles are separated and the chest is opened to access the heart
• The lung is deflated so as to view the ductus arteriosus
• Next, the surgeon places clamps at both the ends of the ductus arteriosus that is connected to the pulmonary artery and aorta
• The blood vessel is cut and either ends sewn together to avoid bleeding from the aorta or the pulmonary vein
• Before repositioning the muscles and tissue, the surgeon may wait and examine if the sewn ends bleed
• The muscles, tissues, and skin are then closed layer-wise with strong sutures
• Mostly a catheter is left in the lung to allow flow of air, and allow the lung to re-inflate again within 24-48 hours

Where is the Procedure Performed?

A Ductus Arteriosus Closure procedure is performed in a hospital. The patient is admitted, undergoes the procedure and is discharged as per the instruction of the physician.

Who Performs the Procedure?

The procedure is performed either by a cardiovascular surgeon or a pediatric surgeon, along with an anesthesiologist.

How long will the Procedure take?

The surgery may take anywhere between 2-3 hours.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the surgical procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

• No particular preparations are needed prior to the procedure
• However, the physician may evaluate the patient’s medical history to gain a comprehensive knowledge of the medications that are being taken currently
• Some of the medication may increase the patient’s chances of bleeding and hence the physician may recommend them to stop such medications for a period of time before performing the procedure
• Sometimes blood test might be performed to determine if the patient has a bleeding tendency or any other medical conditions that prevents them from undergoing the procedure
• The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
• A physician will request consent for the Ductus Arteriosus Closure surgical procedure using an Informed Consent Form.

What is the Consent Process before the Procedure?

A physician will request your consent for the Ductus Arteriosus Closure procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Ductus Arteriosus Closure surgical procedure?

Before a Ductus Arteriosus Closure procedure, the patient has to undergo certain tests such as:

• Routine blood and urine analysis
• ECG (Electrocardiogram)
• Echocardiogram
• X-ray of the chest
• Cardiac catheterization
• CT Scan
• MRI (Magnetic Resonance Imaging)

The physician may suggest further tests depending on the health of the patient and their medical history. Do note that the patient may have to do all or a few of the above tests.

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is a Ductus Arteriosus Closure procedure?
• Why is this procedure necessary? 
• What does the procedure involve?
• How will this procedure help?
• How soon should I get it done? Is there an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed?
• How many such procedures have you (the physician) performed?
• What are the risks while performing the procedure?
• What are the complications that might take place while recovering?
• How long will it take to recover?
• Are there any lifestyle restrictions or modifications required, after the procedure is performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
• Is there any medication that needs to be taken for life, after the procedure?
• What are the costs involved?

During the Ductus Arteriosus Closure surgical procedure:

What kind of Anesthesia is given, during the Procedure?

During the procedure the patient is administered general anesthesia.

How much Blood will you lose, during the Procedure?

The procedure is an open heart surgery; hence, the amount of blood lost is more and may vary from patient to patient. In most cases, the patients will need a blood transfusion, if there is an excessive loss of blood.

What are the possible Risks and Complications during the Ductus Arteriosus Closure surgical procedure?

The possible risks or complications that may arise during the surgery are:

• Excessive bleeding
• Infection
• Accidental injury to the heart, neighboring tissue or blood vessels
• Nerve injury
• Breathing problems
• Cardiopulmonary complications

What Post-Operative Care is needed at the Healthcare Facility after the Ductus Arteriosus Closure surgical procedure?

The healthcare facility must have a pediatric intensive care unit (ICU) where the patient may recover post-surgery. Apart from this no particular care is needed, unless complications arise.

After the Ductus Arteriosus Closure surgical procedure:

What are the possible Risks and Complications after the Ductus Arteriosus Closure surgical procedure?

Post Ductus Arteriosus Closure surgery, the following complications may arise:

• Infection in the surgical wound

What is the Prognosis after the Surgery?

The recovery from the procedure is usually excellent.

When do you need to call your Physician?

Do contact your physician/surgeon if you notice any of the following symptoms:

• Swelling and redness around the incision site
• Bleeding or drainage
• Constipation
• Fever
• Dizziness
• Muscle ache
• Nausea or vomiting
• Signs of Infection
• If any new symptom or discomfort is observed

What Post-Operative Care is needed at Home after the Ductus Arteriosus Closure surgical procedure?

At home, the following post-operative care is recommended, after Ductus Arteriosus Closure procedure:

• Complete the course of medication
• Keep the incision site clean and dry
• Wash the incision site with mild soap while bathing
• Use warm compress to reduce swelling and pain, or follow the physician’s instructions
• Avoid taking non-prescribed medications

How long does it normally take to fully recover, from the Procedure?

It takes about 4 weeks to completely recover from the procedure.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The procedure does not involve the surgical removal of any tissue.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

Since no tissue is removed during the procedure, a pathologist does not get involved in the care of the patient.

Who will you receive a Bill from, after the Ductus Arteriosus Closure surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The hospital
• The cardiovascular surgeon or pediatric surgeon
• An anesthesiologist (if anesthesia was administered)

The patient is advised to inquire and confirm the type of billing, before a Ductus Arteriosus Closure surgical procedure is performed. 

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA