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Babies are born with a natural opening in the heart between the aorta and pulmonary artery called the ductus arteriosus. Under normal circumstances, this vessel closes naturally or becomes tiny within the first few days of life. However, in some babies, particularly those born early (premature neonates), this hole remains open. This is called a patent ductus arteriosus or persistent ductus arteriosus.
A patent ductus arteriosus (PDA) is a congenital heart defect where the ductus arteriosus stays open and causes oxygen-rich blood to return to the lungs instead of going to the rest of the body. This means that blood vessels in the lungs have to handle more blood than normal, which causes the heart and lungs to overwork and makes breathing more difficult. A PDA can also cause problems with feeding, weight gain and blood circulation.
Approximately 1 in 2,000 babies (less than 1%) are born with a PDA. Premature babies are significantly more likely to have a PDA (between 20% and 60%). A PDA may be present with other congenital heart defects.
How we treat PDAs
PDA treatment options for premature infants include:
Observation: Doctors will closely monitor the heart and blood vessel to determine whether the PDA is closing properly or too small to cause a problem.
Medication: In premature infants, an intravenous (IV) medication called indomethacin may help close a PDA.
Open-heart surgery: Doctors can also close a PDA through open-heart surgery, where they open the chest between the ribs to tie off or clamp the duct. Babies who have heart surgery face more risk and longer recovery time.
Transcatheter closure: Doctors can insert a soft, wire mesh PDA closure device through a catheter (a long, narrow tube) to stop blood flow through a PDA.
What is transcatheter PDA closure?
A transcatheter PDA closure is a minimally-invasive (non-surgical) procedure to close the ductus arteriosus. Specialized heart doctors called pediatric cardiac interventionists use a procedure called cardiac catheterization to place a small device in the vessel, which closes the PDA.
This procedure is also called “minimally-invasive PDA closure” or “PDA occlusion.” (Occlusion means blocking or closing a blood vessel.)
Transcatheter vs. surgical closure of PDA
For many babies, a transcatheter PDA closure is usually preferable to open-heart surgery because it presents less risk and shorter recovery time. Premature babies who have surgery to close their PDA may face a difficult recovery in the Neonatal Intensive Care Unit (NICU). Babies who have the non-surgical PDA closure procedure usually recover quickly and with little disruption to their other neonatal care.
Why choose Children’s Hospital Colorado for PDA closure?
Our Cardiac Catheterization Program is the only program in Colorado and the surrounding region to offer PDA closure for newborn babies without open-heart surgery. Here, we are equipped to provide non-surgical PDA closure for neonates as young as 3 days old and as small as 1.54 pounds (700g).
At Children’s Colorado, our nationally-ranked pediatric Heart Institute cares for more babies and children with congenital heart defects than any other hospital in the region. This means we have more experience and more experts to care for children with heart problems than any other hospital nearby. Additionally, our NICU is a nationally recognized leader in caring for premature infants and babies facing critical illness.
Our interventional cardiologists will insert a catheter into the femoral vein in the baby’s groin. Using X-ray imaging, they will guide the catheter to the heart and locate the PDA. Next, they will insert an occlusion device through the catheter and into the baby’s PDA. The most commonly used device for very small babies is the Amplatzer Piccolo™ Occluder device. It is made of nitinol wires that allow it to return to its shape after passing through the delivery catheter. Once in place, this device will block the vessel and stop blood from flowing into the lungs. Finally, doctors will carefully remove the catheter and cover the access point at the groin with a small bandage.
The PDA closure device remains permanently implanted in the heart. Over time, the body’s natural healing process will cover the device with tissue. Your baby’s heart will continue to grow with the device.
The transcatheter PDA closure will take approximately 45 minutes.
What to expect after non-surgical PDA closure
After the procedure, we will bring your baby back to the NICU where we will monitor them closely for the next 24 to 48 hours. Circulation, breathing and feeding should improve soon after the procedure.
Your baby may experience some discomfort at the catheter access point. Our care team will keep a close eye on your child to ensure they are comfortable.
Following PDA closure, we will continue to care for your baby in the NICU until they are well enough to go home.