Patent ductus arteriosus

Abstract

In the absence of irreversible pulmonary hypertension, closure of clinically detectable patent ductus arteriosus (PDA) is usually recommended in adults. Device closure obviates the need for general anesthesia and a surgical incision and eliminates postoperative pain, long convalescence, and lifelong scarring. Over the past 20 years, the efficacy and safety of transcatheter device closure of PDA in adults has been established. Even though the immediate success rate is lower with transcatheter device closure than with surgical closure, transcatheter reintervention for residual clinical shunts is very effective at abolishing residual leaks. The late complete closure rate, as determined by echocardiography, is very similar with surgical closure and with device closure. The clinical significance of silent residual shunts is unknown. In patients with silent residual shunts, the use of prophylactic antibiotics is as of yet recommended. Occlusion devices should be used whenever possible in adults, and surgical closure of patent ducts should be reserved for patients with larger ducts. The method of ductal closure should be selected on the basis of the quality of and experience with available interventional and surgical resources. Emerging minimally invasive surgical treatments seem promising, but further experience and follow-up are needed before widespread application of these techniques can be recommended.

Echocardiography for Patent Ductus Arteriosus Including Closure in Adults

“…When an open thoracotomy is selected, a muscle-sparing left posterolateral incision is preferred. 57 The main indications favoring surgical closure in adults with PDA are calcification of the ductus, short/wide ductus, aneurysms, or in the presence of concomitant defects requiring surgery. 58 PDA Closure in the Elderly: Even in symptomatic elderly patients PDA closure can be controversial due to the risks involved due to technical difficulties, ductal calcification/friability ( Fig.…”

Esophageal stethoscope: an old tool with a new role, detection of residual flow during video-assisted thoracoscopic patent ductus arteriosus closure

“…Closure of an isolated PDA diagnosed in infancy removes the hemodynamic burden of the shunt that may be responsible at times for severe congestive heart failure. In older children or adults, suppression of the shunt is advised to prevent infection (endocarditis), pulmonary hypertension, heart failure, aneurysm formation, and pulmonary or systemic thromboembolism and to avoid the associated shortened life expectancy [7].…”

Esophageal Stethoscope in Thoracoscopic Interruption of Patent Ductus Arteriosus

“…In older children or adults, suppression of the shunt is advised to prevent infective endarteritis, pulmonary hypertension, heart failure, aneurysm formation, pulmonary or systemic thromboembolism, and to avoid the associated shortened life expectancy. 4 Although PDA ligation via thoracotomy is a highly successful procedure, the advantages of VATS ligation include better preservation of pulmonary mechanics, shorter hospital stay, decreased postoperative pain, and prevention of post-thoracotomy syndrome which is characterized by spinal column and chest wall deformities that may proceed to decrease pulmonary function. 5 Video-assisted thoracoscopic surgery offers other advantages to pediatric patients, including decreased incidence of scoliosis after thoracotomy, reported to be 22% to 33%.…”