PDA is an abbreviation for patent ductus arteriosus, a common congenital heart defect diagnosed in newborns and infants. Actually, every human being is born with one. But in most of us, it closes in the first day or two of life as the newborn takes its first breaths. A persistent PDA (one that does not close) thus remains as a persistent connection between the aorta and the pulmonary artery. This allows blood to flow through this connection, which would ordinarily not be allowed. Over time (months) this abnormal flow damages the lungs and causes the heart to enlarge and fail. Before the advent of safe surgery, patients would die from the heart failure and lung damage as infants and toddlers.
Thankfully, a PDA can be closed now in almost all patients, and most go on to be unaffected by it of the rest of their lives. As many premature infants have PDAs, it is important to remember that they may have limitations from other conditions associated with being premature. The PDA itself, however, once closed, will not serve to limit the quality of daily life. Nowadays, many PDAs can be closed without even making an incision. This is known as the catheter closure technique in which the connection is closed using a coil placed through an IV.
Many patients (particularly smaller, sicker newborns infants) will still require an incision and thus the classic “surgery” approach. When surgery is required, there are numerous different possible incision types; even after incision is made, there are different techniques of closure, and it is important for your child’s pediatric heart surgeon and cardiologists to be familiar with all of the incision and closure techniques in order to obtain the best possible result.
When an incision is required (the classic “surgery” approach), our preferred technique is to place an incision of the side of the chest (known as a thoracotomy) and use a metal clip to seal off the PDA. The side of the chest the incision is made on (left or right) depends on the specific anatomy of the patient. The metal clip causes no further problems as the child grows or down the road. Sometimes a suture is used to tie off the PDA instead of a clip. PDA is also present in many more complicated pediatric heart defects, and we thus also have experience closing PDAs from a variety of different incisions, exposures and techniques. This allows us to tailor your child’s surgery to the situation at hand to obtain the best possible result.
At Rady Children’s Hospital-San Diego, our surgeons and cardiologists have been treating PDA in all its possible forms for more than 30 years. When we meet with you and your child, we will discuss the specific risks for your individual, unique situation.