Percutaneous transcatheter closure of patent ductus arteriosus
CPT4 code
Name of the Procedure:
Percutaneous Transcatheter Closure of Patent Ductus Arteriosus (PDA)
Summary
In layman's terms, this is a minimally invasive procedure where a small device is inserted through a blood vessel to close a hole in the heart known as a patent ductus arteriosus, which normally closes after birth but remains open in some individuals.
Purpose
This procedure addresses a patent ductus arteriosus (PDA), a congenital heart defect where a blood vessel called the ductus arteriosus fails to close after birth. The goal is to stop abnormal blood flow between the aorta and the pulmonary artery, preventing complications like heart failure and inadequate oxygenation.
Indications
- Heart murmur detected by a doctor
- Symptoms of heart failure (e.g., rapid breathing, difficulty feeding in infants)
- Poor growth in infants
- Risk of bacterial endocarditis
- Pulmonary hypertension
Preparation
- Fasting for several hours prior to the procedure
- Pre-procedure physical exam and history review
- Diagnostic tests such as echocardiogram, chest X-ray, or EKG
- Blood tests to assess overall health
Procedure Description
- The patient receives anesthesia or sedation for comfort.
- A catheter is inserted through a small incision, typically in the groin, and guided to the heart.
- Contrast dye is injected to provide imaging guidance.
- A closure device, such as a coil or occluding device, is delivered through the catheter and positioned in the PDA.
- The device is deployed to close the PDA, and the catheter is removed.
- The insertion site is closed and bandaged.
Tools and Equipment Used
- Catheter
- X-ray or fluoroscopy machine for imaging
- Contrast dye
- Closure device (coil or occluding device)
Duration
Typically takes 1 to 3 hours.
Setting
Performed in a hospital, specifically in a catheterization lab.
Personnel
- Interventional cardiologist or pediatric cardiologist
- Nurses
- Anesthesiologist/Anesthetist
- Radiology technicians
Risks and Complications
Common Risks:
- Bleeding or bruising at the insertion site
- Infection
- Allergic reaction to contrast dye
Rare Risks:
- Displacement or migration of the closure device
- Injury to blood vessels or heart
- Residual leak
- Blood clots
Benefits
- Immediate improvement in symptoms and heart function
- Minimally invasive with shorter recovery time
- Reduced risk of future complications such as heart failure or pulmonary hypertension
Recovery
- Overnight observation in the hospital
- Instructions for care at the insertion site
- Restrictions on physical activity for a few days
- Follow-up appointment for echocardiogram to confirm closure success
- Regular monitoring by a cardiologist
Alternatives
- Surgical Closure of PDA: More invasive, longer recovery, but sometimes preferred in certain situations.
- Medication: Indomethacin or ibuprofen to induce closure, often used in premature infants.
Pros and Cons of Alternatives
- Surgery: Effective but involves a larger incision and longer recovery.
- Medication: Non-invasive but less effective in older children and adults, not always successful in closing PDA.
Patient Experience
- During the procedure: Patient is usually under sedation or general anesthesia, so no discomfort is felt.
- After the procedure: Mild soreness or bruising at the insertion site; some may feel tired.
- Pain management includes over-the-counter pain relievers if needed.
- Most patients can resume normal activities within a few days.