Closure of a Patent Ductus Arteriosus (PDA). PDA may occur in association with other structural defects which may also require correction. Closure of a PDA is necessary to prevent heart failure in early life or the risk of endocarditis or pulmonary vascular disease in later life.

Preoperative Preparation

In premature infants a trial of indomethacin may help to close a PDA.

Anaesthesia

General

Position

Supine with the left side of chest supported with sand bags.

Incision

Left anterro-lateral thoracotomy through the left 4th or 5th intercostal space.

Procedure

• Ductal communication between the arch of aorta & the pulmonary artery is exposed.
• The recurrent laryngeal nerve is identified & the patent ductus is ligated & divided.

Percutaneous Closure

An umbrella-shaped device can be introduced through the large veins to the right side of the heart & into the pulmonary artery under radiological control.