Centers of Excellence in Interventional Cardiology and Radiology

Congenital Heart Disease

Patent ductus arteriosus (PDA)

The procedure performed by team of specialists from abroad!

We have opened the first section for Percutaneous Closure of Congenital Heart Diseases in Romania!

The most modern equipped angiography room , an exceptional medical team

We have the most famous abroad specialists! Team from Romania, Israel, Greece and Germany!

We have the largest experience. The youngest child was treated at the age of 5 days! Call now us!

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031 9300

Generalities

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During fetal life, the fetus receives oxygen from the mother through placental blood circulation, so the blood is by-passing de pumonary circulation. The blood is deviated in the systemic circulation through one artery, know as ductus arteriosus, wich bends the pulmonary artery with the descending aorta.

At birth, with the onset of normal respiration (with the first breath), there are some changes involving the heart and the lungs. Although functional closure usually occurs in the first few hours of life, true anatomic closure, in which the ductus loses the ability to reopen, may take several weeks. A second stage of closure related to fibrous proliferation of the intima is complete in 2-3 weeks. Sometimes, ductus arteriosus doesn’t close due to several factors, so the blood is passing from the systemic circulation in the pulmonary circulation, and this condition is know as patent ductus arteriosus (PDA).

Clinical manifestation of PDA depends of the blood flow wich passes in the pulmonary circulation, and this also depends on the size of ductus arteriosus and the pressure gradient (difference) between the two circulatory systems ( pulmonary and systemic).

Typically, patients with small PDAs are asymptomatics, and the deffect is and the diagniosis, in this case, is accidental, during some routine tests.69

Patients with a moderate-to-large PDA may present various symptoms, such as exertional dyspnea to congestive heart failure. Adults whose large patent ductus arteriosus (PDA) has gone undiagnosed may present with changes in the pulmonary circulation wich are the cause of shunt reversal (flow direction through PDA reverses) – Eisenmenger syndrome.

Spontaneous closure of the patent ductus arteriosus (PDA) is common. Intravenous (IV) indomethacin (or the newer preparation of IV ibuprofen) is frequently effective in closing a patent ductus arteriosus (PDA) if it is administered in the first 10-14 days of life. Other options are catheter closure and surgical ligation.

Indications

After running some tests, the cardiologist will be able to take the decision for surgical or nonsurgical PDA’s closure. PDA’s closure is recommended for patients presenting with symptoms and/or affecting right heart cavities, due to patent ductus arteriosus.

Also, PDA’s closure may be considered in case of small PDA’s associated with a systolic heart murmur, because of long term beneffits.

Usually, silent PDA’s ( without any systolic murmur) should not be treated. Contraindications to catheter-based closure involve patients presenting with Eisenmenger syndrome due to PDA.

Procedure

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The use of the percutaneous route to close the patent ductus arteriosus (PDA) is becoming more common. Transcatheter occlusion is an effective alternative to surgical intervention and is becoming the treatment of choice for most cases of patent ductus arteriosus (PDA) in children and adults. Most patients with an isolated patent ductus arteriosus (PDA) can have successful treatment by catheterization after the first few months of life.

The procedure is performed in cathetersim lab, using electrocardiographic control. Usually, it is done under general anesthesia; but sometimes, may be performed using local anesteshia and sedatives. Thus, after local asepsy, a small inguinal incision is made. Through this incision, the physician will introduce a small narrow tube into the femoral artery, then through this tube a catheter will be introduced which will reach the heart, under fluoroscopic control (X ray control). 70The interventionist will perform an angiogram, so the PDA will be visualized. Also, another catheter will be introduce in femoral vein and this one also, using fluoroscopic control, will be advance until will reach the right cavities and the pulmonary artery. The physician will then introduce over the catheter a small device (at this time the device is folded) which will be placed at the level of the PDA. Once in the desired position (the correct position is controlled both by radiological images and transesophageal echocardiography), the device, will be opened and will obstruct the ductus.

The device will be covered with normal tissue produced by the human body for the next 3-6 months.

Is it painful?

No, usually, the intervention is performed under general anesthesia.

How long does it take?

The duration of the procedure is about 1-2 hours and takes place in the cardiac catheterization laboratory.

Risks

The complications are rare; the complications are reduced by the proper preparation and the continuous surveillance of the patient. Potential complications:

• allergic reactions to administered substances, including renal disfunction

• reactions to anesthetic compounds

• arteriovenous fistulas at the vascular puncture site

• minor bleeding at the vascular puncture site

• fever

• headache, migraine

• infection

• gaseous embolism

• cardiac arrythmias

• extremely rare – cardiac perforation and cardiac tamponade (perforation of the cardiac wall and bleeding in the pericardial sac, which compresses the heart)

• embolization or device migration – in the case of device embolization, the device can usually be retrieved by transcatheter techniques, and a second device can be successfully placed in the patent ductus arteriosus (PDA)

• stroke

• partial occlusion of pulmonary artery

• myocardial infarction

Before procedure

The preoperative assessment will establish if the closure of the defect can be done percutaneously or there is an indication of surgical closure of the defect. Physical examination and echocardiography are key elements which help making a decision.

Prior to the intervention, the interventional cardiologist must be prevented about any history of allergic reactions. Blood tests are taken including hemoglobin level, coagulation, renal function, and other specific tests.

The patient is admitted the day before the intervention, and he/she should not eat before the procedure.

After procedure

You will be connected to monitors that will constantly display your electrocardiogram (ECG or EKG) tracing, blood pressure, other pressure readings, breathing rate, and your oxygen level. You will be given pain medication for incisional pain or you may have had an epidural during surgery which will help with postoperative pain.

Since the procedure is minimally invasive, the postprocedural recovery is usually very fast. The majority of patients can leave the hospital the following day. Indications about recovery and postprocedural treatment will be clearly specified to all patients. Treatment with aspirin must be administered 6 months post intervention in order to prevent blood clot formation within the device. After 6 months it is considered that the device is completely covered by the formation of epithelial tissue, and the risk of blood clot formation disappears.

Also, in the first six months the prevention of infectious endocarditis is mandatory – antibiotic treatment (unique dose of amoxicilin, ampicilin, or clindamicin in case of pennicilin allergy) before any dental procedure carrying a risk of microbial translocation into the bloodstream. Infectious endocarditis prophylaxis is also needed in other several situations, which will be explained by our physician.

Important!

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The percutaneous closure of PDA is the first choice for treatment of PDA. It’s a minimally invasive procedure, so the recovery will be rapid. Physical exertion can be performed after one month post procedure. The physician must be informed of any complications in the postintervention period.

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Sună Mesaj