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Patent Ductus Arteriosus Ligation

Patent ductus arteriosus (PDA) ligation is a corrective surgical procedure for children whose ductus arteriosus does not close after birth. The ductus arteriosus is a blood vessel joining the pulmonary artery (main artery to the lungs) to the aorta (main artery to the body). In the fetal heart, blood bypasses the lungs and gets oxygen from the placenta. When the newborn’s lungs take over at birth, the body stops producing the chemicals that keep the ductus arteriosus open, and it closes naturally. If it fails to close, a patent or open ductus arteriosus occurs, resulting in too much blood flowing to the lungs. If the patent ductus arteriosus is large, it may cause poor eating and growth, fast breathing, easy tiring, rapid heart rate, and frequent lung infections. The goal of treatment is to close the patent ductus arteriosus to prevent complications and reverse the effects of the increase in blood volume.

Preparation
  • The patient will be prepared for physical cleanliness, and refrain from wearing any metallic ornaments, holy threads and nail lacquer.
  • Stop some medications at least 7-10 days before operation such as aspirin or some heart medicines which will be instructed by the physician.
  • Inform the physician if the patient or siblings have a record of easy bleeding, difficult blood clotting or bruise on the body.
  • The operation should be pending if the patient has a cold or fever.
  • If the patient has tooth decay, please see the dentist before undergoing the operation to avoid the risk of respiratory and heart infections. Small children and children with cyanosis are excluded as they might encounter complications during dental treatment.
  • The patient should refrain from food and drink according to the anesthetist’s scheme.

During the procedure, the patient will be under general anesthesia. The surgeon will make a small incision on the left side of the chest in between the ribs. Once the surgeon reaches the patent ductus arteriosus, the open duct will be repaired with stitches or clips. Once the ligation is complete, the surgeon closes the wound.

After surgery, the patient will be in an intensive care unit. A number of systems are used to monitor the patient's heart rate and rhythm, blood pressure, temperature, and breathing rate. Monitoring is gradually discontinued as the person recovers. The patient will be expected to be in the hospital about one week.

Before leaving the hospital, the family will be instructed on how to care for their child at home. This includes information on medications, caring for the incision, and activity limitations. Within a few weeks, the child should fully recover and be able to take part in normal activities. After successful surgery, children generally do not have any symptoms and lead normal lives.

Let the doctor know if the patient develops problems, such as:

  • Bleeding or swelling at the incision site
  • Signs of infection such as redness, drainage, or fever
  • Chest pain or shortness of breath
The risks of patent ductus arteriosus ligation include the following:
  • Bleeding
  • Infection
  • Paralyzed diaphragm (muscle below the lungs)
  • Adverse reaction to medication
  • Arrhythmias (irregular heartbeat)
  • Damage to blood vessels
  • Fluid around the lungs
  • Death
Before the procedure
  • The patient should plan to stay in Thailand for at least 2-3 weeks through the duration of the treatment.
  • It is recommended that the patient stay in a hotel close to the hospital for convenience in traveling to the hospital before and after the procedure or from the day of the procedure to the day of the follow-up appointment.
After the procedure
  • At the follow-up appointment the patient will undergo a physical examination and the wound will be checked. The patient will receive documentation regarding the surgery or procedure and all other relevant documentation for traveling.
  • Clean the incision site by bathing and using soap daily. Pat the incision dry. Do not apply any cream, lotion, or powder to the site. Please contact the doctor immediately if there are any signs of infection.
  • When traveling by air, if the patient is seated in Economy Class, please choose an exit row or bulkhead seat for convenience in getting up and moving around every 15-30 minutes. Flex the ankles regularly to prevent deep vein thrombosis.
  • Please take all medication prescribed by the doctor. Carry the appropriate dosage of mediation in the carry-on luggage when traveling as well as a few extra doses in case of an emergency. Carry the prescription for all medications to avoid problems at the airport.
The success of the procedure depends on a number of factors. Please discuss the likelihood of success with the doctor before the procedure.
 
What if this procedure is not performed?
Patent ductus arteriosus causes too much blood to circulate to the lungs and heart. If not treated, the blood pressure in the lungs may increase (pulmonary hypertension) and the heart may weaken. Other potential complications include an infection in the heart (endocarditis) and irregular heartbeat (arrhythmia).

Medication or catheter-based procedure.

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