PDA Closure without Surgery

By: Prof. Dr. Şükrü Akyüz

In the womb, the baby (foetus) has a vein that connects the two large veins coming out of the heart. This is a normal part of the baby’s circulatory system. After birth, when the baby begins to get oxygen from its own lungs, this connecting vessel is no longer needed and closes in most people. However, it may rarely remain open for various reasons. This open connection is called patent ductus arteriosus (PDA) (patent: open, ductus: connection, arteriosus: artery).

PDA kapatma
Damar bağlantısının kapanarak bir bant haline gelmesi (Nationwide Children’s Hospital web sitesinden alıntılanarak yeniden düzenlenmiştir.)
PDA kapama
Damar bağlantısının açık kalması (Nationwide Children’s Hospital web sitesinden alıntılanarak yeniden düzenlenmiştir.)
PDA'nın kapatılması
PDA'nın tıpayla ameliyatsız kapatılması (Nationwide Children’s Hospital web sitesinden alıntılanarak yeniden düzenlenmiştir.)

When is the PDA switched off?

As a result of blood escaping through the PDA, the left side of the heart is filled with more blood than it should be and the left side of the heart may enlarge over time. If the heart has enlarged, the PDA should be closed. However, in very advanced cases, closing the ASD is unfortunately not beneficial; it may even cause harm. If the PDA is very small, i.e. the amount of escaping blood is so small that it does not cause any complaints and the heart is of normal size, there is no need to close the PDA.

What is the success rate of PDA closure by non-operative method?

Overall, the technical success rate is >95%.

What are the risks of PDA shutdown?

Like any interventional procedure, this procedure is not without risks. However, these are very rare. Major complications, such as dislodgement of the device acting as a stopper or the formation of a clot on the device, occur in 3 out of every 100 people; death occurs in 1 out of every 1000 people.

I am concerned about these risks, what should I do?

You may be right to be concerned, but remember: These complications are very rare. The important question is whether the procedure is really necessary. If the decision is made in accordance with current scientific data and guidelines, avoiding the procedure means that you are exposing yourself to a much higher risk of heart failure.

PDA kapama
PDA kapatma cihazları

Which examinations are performed before PDA closure and for what purpose?

  • Blood test: to check for anaemia, kidney failure and other diseases such as infection.
  • ECHO (ultrasound of the heart): To confirm the presence of a PDA and to determine whether there is any additional heart disease.
  • CT (computerised tomography): To plan the technique to be applied in the procedure and to determine the type of device to be used.

How long does the procedure take?

Usually 1 hour. However, this time may be shorter or longer depending on the anatomical features of the PDA.

Is the procedure performed by stopping the heart, as in heart surgery?

No, it’s not. It’s done when the heart’s working.

How many days will I stay in hospital after the procedure?

Most patients are discharged the next day.

Will I feel pain during the PDA closure procedure?

No, it is not. The vascular access site is anaesthetised and the patient remains awake throughout the procedure. Relaxing medication may be given to relieve stress.

Will the PDA switch-off device move afterwards?

Although there have been cases reported in the literature where the device was found to have moved afterwards, this is very rare. It is not possible to move the device after it is covered with tissue within a few months.

Will I feel the device on my body after the procedure?

No.

Will the device stay in my body for life?

Yes. It is not possible to remove the device.

Will I use blood thinners after PDA closure?

Yes. Usually, low-dose aspirin (Coraspin or Ecopirin) is used for 6 months. After 6 months, there is no need to use blood thinners.