Repair of patent ductus arteriosus; by division, younger than 18 years
CPT4 code
Name of the Procedure:
Repair of Patent Ductus Arteriosus (PDA) by Division (Younger than 18 years)
Summary
The repair of a patent ductus arteriosus (PDA) by division is a surgical procedure used to correct a congenital heart defect. In simpler terms, it involves closing an open blood vessel (ductus arteriosus) that should normally close soon after birth but remains open in some children, leading to heart and lung issues.
Purpose
The primary medical condition this surgery addresses is a patent ductus arteriosus, where the ductus arteriosus fails to close naturally after birth. The goal of the procedure is to prevent complications such as heart failure, pulmonary hypertension, and other serious conditions by closing the open duct. The expected outcome is improved heart function and overall health.
Indications
- Diagnosed PDA through echocardiogram or other imaging tests.
- Symptoms such as rapid breathing, poor growth, or heart failure in infants and children.
- Significant left-to-right cardiac shunting demonstrated on medical imaging.
- Failure of the ductus arteriosus to close with medical management or when medication is not suitable.
Preparation
- Fasting for a specified time before the procedure (generally 6-8 hours).
- Pre-operative blood tests, chest X-rays, and echocardiograms.
- Detailed medical history review and physical examination.
- Discussion of the procedure and risks with the healthcare team.
- Anesthesia assessment and meeting the anesthesiologist.
Procedure Description
- Anesthesia: The patient is placed under general anesthesia.
- Incision: A small incision is made, usually on the side of the chest.
- Exposure: The surgeon carefully exposes the ductus arteriosus.
- Division: The PDA is either tied off or clipped to close it completely.
- Closure: The incision is closed with sutures, and dressings are applied.
Specialized surgical tools and imaging equipment are used to ensure precision.
Duration
The procedure typically takes about 2 to 3 hours.
Setting
It is performed in a hospital setting, specifically in a pediatric cardiac surgical suite equipped with specialized equipment.
Personnel
- Pediatric Cardiac Surgeon
- Pediatric Anesthesiologist
- Surgical Nurses
- Respiratory Therapist
Risks and Complications
- Infection
- Bleeding
- Residual PDA or need for further surgery
- Injury to surrounding structures such as the laryngeal nerve
- Problems related to anesthesia
Benefits
- Correction of the abnormal blood flow, reducing symptoms and preventing complications.
- Improved quality of life and growth in affected children.
- Benefits are typically realized shortly after recovery.
Recovery
- Hospital stay for 3-7 days post-surgery.
- Pain management with medications.
- Gradual return to normal activities over 4-6 weeks.
- Follow-up visits with the cardiologist for monitoring and echocardiograms.
Alternatives
- Medication to encourage PDA closure in infants.
- Catheter-based closure procedure for appropriate cases.
- Each alternative has varying success rates and risks; surgical division is considered when others are not suitable or have failed.
Patient Experience
During the procedure, the child will be under anesthesia and won't feel any pain. After the surgery, mild to moderate pain, manageable with medication, should be expected. Encouragement of comfort measures like cuddling, soft toys, and soothing environments helps in recovery. The supportive care team will closely monitor and manage any discomfort or concerns.