How Do you Close a Patent Ductus Arteriosus?
A Patent Ductus Arteriosus (PDA) is a passage between the aorta and the pulmonary artery.
To close a PDA, access to the heart is gained by inserting two tubes under local anaesthetic into the femoral vessels, located at the top of the leg at the level of the skin fold of the hip. Access to the left side of the heart is through a tube in the femoral artery and access to the right side of the heart is through a tube in the femoral vein.
The tube is passed up the artery to the aorta, just after the branch to the left arm. A wire is carefully directed through the PDA into the pulmonary artery. A second tube is passed from the femoral vein up to the right atrium, through the tricuspid valve into the right ventricle and then through the pulmonary valve into the pulmonary artery. A loop snare is used through the second tube to capture the end of the first wire and then to pull it back out of the femoral vein. This completes a loop of wire that passes into the body at the femoral artery, up to the chest and through the PDA before returning down the leg and out of the body through the femoral vein.
Once that wire loop is in place, a delivery tube is passed up to the heart and through the PDA from either the artery (left side) or vein (right side). The wire is then removed and the chosen PDA device is delivered to the PDA. Once the first disc is deployed on the far side of PDA, the tube is withdrawn and the second disc is deployed on the near side. Once the position has been confirmed on x-ray imaging, the device is released from the delivery cable and the tubes removed from the leg.
Over the next six months, the patient’s cells heal over the device incorporating it into the wall of the aorta and pulmonary artery.
Dr McGaw has expertise in this procedure.