What is a Patent Ductus Arteriosis?
The Ductus Arteriosis is a connection between the aorta and the pulmonary vein. It serves an important role in fetal life allowing blood to bypass the lungs in utero. After birth, the ductus should close and allow good separation of pulmonary and systemic blood. In some infants, the ductus stays open and steal blood away from the kidneys, intestines, and rest of the body. The blood destined for these locations is recirculated to the lungs. The recirculated blood overloads the lung while robbing the rest of the body. Indomethacin can close the ductus in many cases. For older children, the cardiologist may be able close with ductus with a special cardiac cath device. Small and premature children who fail to close their duct with medicine may require surgical closure.
The surgery is done through an incision in the left chest. The lung is retraced away from the aorta. The recurrent laryngeal nerve (nerve to the left vocal cord) is moved away from the aorta and the ductus is dissected. A titanium clip is used to close the ductus.
The risks of the surgery include bleeding, death, injury to the lung, damage to the nerve, incomplete closure, damage to the pulmonary artery or aorta, pneumothorax, and the risk of anesthesia. There may be other risks as well.
Left thoracotomy incision in a premature infant showing the anatomy
Note: The ductus is difficult to see prior to opening the pleura over the descending aorta.
Intra-operative photo of newborn undergoing PDA ligation
Note: The ductus has been occluded with a titanium clip