What are the indications for surgical ligations to treat patent ductus arteriosus (PDA)?

Updated: Nov 20, 2018
  • Author: Luke K Kim, MD; Chief Editor: Stuart Berger, MD  more...
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Answer

With rare exceptions, the presence of a patent ductus arteriosus (PDA) is an indication for surgical closure. Clearly, attention must be paid to the existence of other congenital heart lesions that impair pulmonary blood flow. In these patients, all attempts should be made to preserve ductal flow until a more permanent palliative shunt can be constructed or definitive repair can be undertaken. Very small premature infants still require surgical closure.

In the infant, repair may be urgent for the symptomatic patient with evidence of cardiac or respiratory failure not adequately controlled with medications, or it may be delayed in the patient who is asymptomatic or well controlled on medical therapy.

Postoperative results are best if the patent ductus arteriosus (PDA) is closed while the patient is younger than 3 years. [25] An increased incidence of elevated pulmonary vascular resistance (PVR) and pulmonary hypertension occurs if the lesion closed in those older than 3 years.

Thus, indications for surgical treatment include the following:

  • Failure of indomethacin treatment

  • Contraindications to medical therapy (eg, thrombocytopenia, renal insufficiency)

  • Signs and symptoms of congestive heart failure (CHF)

  • Patent ductus arteriosus (PDA) found in an older infant

  • Infants found to have an asymptomatic patent ductus arteriosus (PDA) after the neonatal period should undergo surgical ligation preferably before the age of 1 year to prevent future complications of a patent ductus arteriosus (PDA)

  • Ductal closure is indicated for cardiovascular compromise (ie, pulmonary complications) and for reduction of the risk of infective endocarditis (subacute bacterial endocarditis)


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