What are the contraindications for surgical ligation 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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The primary contraindication to repair is severe pulmonary vascular disease. If transient intraoperative occlusion of the patent ductus arteriosus (PDA) does not decrease elevated pulmonary arterial pressures with a subsequent increase in aortic pressure, then the closure must be undertaken carefully and may be contraindicated. Closure of the ductus does not reverse preexisting pulmonary vascular disease.

A subset of associated cardiac anomalies—so-called ductal-dependent lesions—depend on flow through the patent ductus arteriosus (PDA) to maintain systemic blood flow. Premature closure of the ductus without concurrent repair of the following defects is contraindicated and may be fatal:

  • Aortic valve atresia

  • Mitral valve atresia with hypoplastic left ventricle

  • Pulmonary artery hypoplasia

  • Pulmonary atresia

  • Severe coarctation of the aorta

  • Tricuspid atresia

  • Transposition of the great arteries

Other contraindications to surgical closure include concurrent uncontrolled sepsis and an inability of the patient to tolerate general anesthesia.

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