| From your Guide Dr.MANI |  | |
Patent Ductus Arteriosus | ||
| From your Guide Dr.MANI | | |
Patent Ductus Arteriosus | ||
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Minimally Invasive PDA closure
The interventional cardiologists - or "catheter-pushers" - entered the scene next. Using a fine tube
threaded into an artery in the groin, they were able to place "coils" made of metal inside the PDA.
When blood comes into contact with these coils, it "clots" - that is, it becomes hard. This clot
blocks the PDA. Over time, a scar forms and the PDA is firmly closed shut. Isn't that smart ?
The surgeon, then, not to be outdone, came up with the idea of minimal intervention surgery. Using
specially designed long instruments passed through small puncture holes in the chest, a metal clip is
placed around the PDA after isolating it. When the clip is applied, the PDA is blocked. If
necessary, this procedure can be performed under anesthesia at the bedside of a sick infant in the
intensive care unit.
Another method, that is sometimes useful and can be tried before surgery, is using a medicine called
INDOMETHACIN. It acts by blocking the effects of PROSTAGLANDIN, which is a natural
substance that keeps the ductus arteriosus open. When prostaglandin is blocked, the ductus
closes.
Why are there so many methods ? Which one is best ?
The very fact that there ARE many methods indicates that there is no "best" one. Each has its own
advantages and drawbacks. The choice for a particular patient must however be made by the
treating physician after analyzing many factors like age, patient's condition, availability and safety of
the different methods, chance of failure and much more. Minimally invasive closure can be used in
very sick new-born children, when surgery may have a high risk. Surgery is useful when other
conditions are also present which need operation.
What are the risks involved in closure ?
PDA closure is a safe procedure - whichever way it is done. When surgical closure is elected, there
is a small risk of injury to a nerve that controls the "vocal cords" - the sound box. If this happens,
hoarseness of the voice may result. The risk of death from surgery is almost ZERO. Again, a small
chance of RECURRENCE - or re-opening - of the closed ductus arteriosus is present with all
types of treatment. This is least when the PDA is divided into two. When a "minimally invasive"
approach is used, sometimes, it is not possible to clearly see or isolate the PDA. Then it may be
necessary to convert to a regular operation to complete the procedure.
What about life after repair ?
The answer in one word is - NORMAL. Late problems are unusual after PDA closure, and
patients return to a normal and productive life. After surgery, hospital stay is usually around 2 to 7
days but differs from one geographic location to another. With catheter-based and minimal invasion
methods, "next day" discharge is routine. Patients can return to work in two weeks time.
If there's anything more you want to read about, or some areas which aren't clear enough, don't
hesitate to write and let me know.
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Copyright 1998, All rights reserved. |
