Patent Ductus Arteriosus Ligation (Patient Information)

Patent Ductus Arteriosus is also called a "PDA." It is a channel or path that connects two large arteries that come out of the top of the heart. The two arteries are called the aorta and the pulmonary artery. Before a child is born, the PDA is called a Ductus Arteriosus or "DA." The DA is important because it causes most of the blood to bypass the lungs. The lungs do not need much blood since unborn babies do not breathe air. The placenta acts like a lung for unborn babies. After birth, babies do not need the DA anymore because they need to have blood going to their lungs. The DA is supposed to close shortly after birth. A DA that does not close after birth is called a PDA.
After birth, a PDA causes some of the blood from the aorta to leak back into the pulmonary artery. This is not supposed to happen since the blood from the aorta has already been to the lungs once. The circling of blood caused by the PDA makes extra work for the heart and lungs. It causes the heart to have to pump harder than normal to send enough blood and oxygen out to the body. In time, this may cause congestive heart failure.
There are always some risks with surgery. Your baby may bleed inside the head or from the place where the PDA was closed. Your baby may get an infection or stomach problems.Your baby's vocal cords may become paralyzed or partly paralyzed. Your baby may get a pneumothorax. This is when air gets inside the chest and stomach area and causes problems. Your baby may die. Without surgery, your baby's heart failure symptoms may get worse.
Before surgery:
Blood Gases:This test is also called an arterial blood gas or "ABG." Blood is taken from an umbilical artery line or "UAC" in the belly button. Blood may also be taken from an arterial line in the arm or leg. If your baby does not have an arterial line, blood is taken from the arm, wrist, leg, or foot. ABGs show caregivers how much oxygen, acids, and carbon dioxide are in the blood.
Blood Tests:Your baby may need blood taken for tests. The blood can be taken from an arterial line or from your baby's heel. Blood tests will show how your baby's body is handling the heart problem and if he is ready for surgery. Your baby may need to have blood drawn more than once.
Chest X-ray:X-rays taken before surgery will show caregivers how your baby's heart and lungs are doing. It can show if the heart is larger than it should be. The X-ray can also show if the aorta or pulmonary artery have gotten larger.
Echocardiogram (eh-ko-kar-d-o-gram):
An echocardiogram is often called an "echo." Sound waves are used to show pictures of the size and shape of your baby's heart on a TV-like screen. An echo and doppler study can tell how your baby's heart moves when it is beating and how blood flows through the heart. It can tell if your baby's heart is pumping well. An echo can also find heart problems, such as problems with the valves of your baby's heart. This painless test is done while lying down.
The test is done in a quiet area with the lights turned off. Clear gel will be used so the echo probe can be rubbed easily across your baby's chest to get a good picture. The clear gel will be cleaned off after the test. This test can tell how well your baby's heart is pumping. An echo can also find fluid around the heart or heart valve problems.
12 Lead EKG:This test helps caregivers see if there are problems caused by the left side of the heart getting larger. Sticky pads (10) are placed on your baby's chest, arms, and legs. Each pad has a wire that is hooked to a machine. This machine prints a paper tracing of your baby's heart beat. This test is painless and takes about 5 to 10 minutes.
Heart Monitor:This is also called an EKG or an electrocardiogram (e-lek-tro-kar-d-o-gram). It is a painless test to see how your baby's heart is working. Sticky pads (3 or 5) are placed on different parts of your baby's body. Each pad has a wire that is hooked to a TV-type screen. This screen shows a tracing of each heartbeat. Your baby's heart is being watched all the time to make sure your baby's body is handling surgery well.
IV lines:Your baby will have one or more IV lines to get fluids, food, and medicines. Your baby will not get food by bottle or gavage tube before surgery.
Pulse Oximeter:This is a machine that tells how much oxygen is in your baby's blood. A cord with a clip or sticky strip is placed on your baby's hand or foot. The other end of the cord is hooked to a machine. Caregivers use this machine to see if your baby needs more oxygen.
Transport:Your baby may be taken to the operating room on an open warmer bed or in a transport unit. The transport unit is a tiny incubator on wheels. It will keep your baby warm and protected on his way to surgery.
Ventilator:Your baby may already be on a ventilator if the PDA is causing heart problems. Your baby may have an endotracheal tube or "ET tube" put down his throat and be put on a ventilator for the surgery. This way your baby will be able to breathe well during the surgery.
Vital Signs:This includes taking your baby's temperature, blood pressure, pulse (count heartbeats), and respirations (count breaths). Your baby may have an umbilical artery catheter (UAC) that will measure blood pressure. If not, caregivers will wrap a tiny cuff around your baby's arm to measure blood pressure. Caregivers will listen for pulse and respirations with a stethoscope. Temperature will be taken by a tiny skin probe taped to the skin or with a thermometer. Caregivers take vital signs often before, during, and after surgery to see how your baby is doing.
General Anesthesia: This is medicine to make your baby comfortable during surgery. The medicine is given as a liquid in his IV. Your baby is completely asleep during surgery.
During Surgery:
Medicine to help your baby relax or make him drowsy may be given through his IV. A caregiver will take your baby to the operating room on an open warmer bed or transport unit. Your baby may be taken to an operating room in the NICU. Your baby will be given general anesthesia to keep him completely asleep. A caregiver will clean your baby's chest with soap and water. An incision (cut) is made between 2 ribs on the left side of your baby's chest.
Suture (thread) or tiny metal clips are used to close the PDA. The PDA is closed at the aorta end and at the other end close to the pulmonary artery. The incision in your baby's chest is closed with a special glue or with stitches or steri-strips. The surgery usually lasts 1 to 2 hours.
After Surgery:Your baby is taken back to his bed space in the neonatal intensive care unit (NICU). Caregivers will watch your baby very closely. You will be allowed to visit your baby after surgery. Some of the same tests that were done before surgery may be also done after surgery. These will help caregivers to know how well your baby is doing after surgery.
Bandages:A bandage may be used to cover your baby's incision. This bandage keeps the area clean and dry to prevent infection. A caregiver may remove the dressing shortly after surgery to check the incision.
Chest tubes:Sometimes chest tubes are put into a baby's chest during surgery. Chest tubes remove air, blood, or fluid from around the lung(s). This lets your baby's lungs fill back up with air when breathing. The chest tubes are attached to a container with bubbling water. After the chest tubes are removed, your baby's lungs should be normal.

Once your caregivers feel your baby is ready, your baby may eat. If your caregiver tells you that you may feed your baby, do not throw away the bottle. Caregivers will need to know how much your baby ate from the bottle.
Medicines:Your baby's caregiver may give your baby one or more of the following medicines.
Antibiotics: This medicine may be given to help your baby's body fight infection. Infection germs are called bacteria. Antibiotics may be given by IV or as a shot.
Heart Medicine: This medicine may be given to make your baby's heart beat better or more regularly. There are many different kinds of heart medicines. Talk with caregivers to find out what your baby's medicine is and why he is taking it.
Diuretics: This medicine may be given to help your baby's body get rid of extra fluid or water. Talk with caregivers to find out what your baby's medicine is and why your baby is taking it.
Pain Medicine:Caregivers may give your baby medicine to take away or lessen your baby's pain. This medicine may be given in your baby's IV.