33820 Repair of patent ductus arteriosus; by ligation

Name of the Procedure:

Repair of Patent Ductus Arteriosus (PDA); by ligation

Summary

Patent Ductus Arteriosus (PDA) repair by ligation is a surgery to close a small, naturally occurring connection between the aorta and pulmonary artery that fails to close on its own after birth. This is usually done to prevent complications associated with improper blood flow.

Purpose

The procedure addresses Patent Ductus Arteriosus, a condition where the ductus arteriosus remains open (patent) after birth, leading to abnormal blood flow between the aorta and pulmonary artery. The goal is to close the PDA to ensure the heart and lungs function normally and to prevent complications like heart failure, pulmonary hypertension, or infective endocarditis.

Indications

• Symptoms like rapid breathing, fatigue, and poor growth in infants.
• Diagnosed PDA on an echocardiogram.
• Risk factors include prematurity, genetic conditions like Down syndrome, or family history of heart defects.

Preparation

• Pre-surgical fasting starting at least 6-8 hours before the procedure.
• Medication adjustments as instructed by the physician.
• Diagnostic tests such as echocardiogram, chest X-ray, and blood tests.

Procedure Description

1. The patient is given general anesthesia.
2. A small incision is made in the side of the chest, between the ribs.
3. Surgical instruments are used to access the PDA.
4. The ductus arteriosus is closed using sutures, clips, or a ligature to tie it off.
5. The incision is then closed with sutures or staples.
6. A chest drain might be placed temporarily to prevent fluid accumulation.

Duration

The procedure typically takes about 1-2 hours.

Setting

The procedure is performed in a hospital operating room.

Personnel

• Pediatric or cardiac surgeon
• Anesthesiologist
• Scrub nurse
• Surgical assistant
• Circulating nurse

Risks and Complications

• Common risks: Infection, bleeding, pain at the incision site.
• Rare risks: Injury to nearby structures, recurrence of PDA, complications from anesthesia, lung issues like pneumothorax.

Benefits

• Closure of the PDA will eliminate improper blood flow.
• Reduced risk of pulmonary hypertension, heart failure, and other related complications.
• Benefits are often realized within days to weeks after recovery.

Recovery

• Post-procedure care includes monitoring in an intensive care unit (ICU) initially.
• Pain management with medications.
• Hospital stay of about 2-5 days.
• Follow-up appointments for monitoring heart function through echocardiograms.
• Patients usually return to normal activities within a few weeks.

Alternatives

• Medication: Indomethacin or ibuprofen in preterm infants to encourage PDA closure.
• Minimally invasive catheter-based techniques: PDA closure with a coil or occluder device.
• Pros and cons: Medications may not always be effective, and catheter-based techniques are less invasive but may not be suitable for all patients.

Patient Experience

• The patient will be under general anesthesia and will not feel anything during the procedure.
• Post-surgery, there may be pain at the incision site, managed with medication.
• Patients may experience some discomfort but are typically able to resume regular activities within a few weeks.