DUCTUS-ARTERIOSUS CLOSURE

General Information

DEFINITION--Closure of an abnormal opening in the ductus arteriosus, a blood vessel between the heart's aorta and the pulmonary artery that usually closes in the first few days of life.

BODY PARTS INVOLVED--Ductus arteriosus.

REASONS FOR SURGERY--For unknown reasons, closure does not always happen. The surgery is performed so that normal growth and development may occur. If the abnormal opening is large, surgery is performed during the first few days after birth. Otherwise, surgery may be delayed until the child is 3 or 4 years old.

SURGICAL RISK INCREASES WITH

• Preterm infants.
• Obesity.
• Recent or chronic illness.

What To Expect

WHO OPERATES

• Cardiovascular surgeon.
• Pediatric surgeon.

WHERE PERFORMED--Hospital.

DIAGNOSTIC TESTS

• Before surgery: Blood and urine studies; x-rays of chest; echocardiogram; cardiac catheterization (sometimes); ECG (See Glossary for all).
• During surgery: ECG monitor (See Glossary).
• After surgery: Blood studies.

ANESTHESIA--General anesthesia by injection and inhalation with an airway tube placed in the windpipe.

DESCRIPTION OF OPERATION

• An incision is made in the chest. The muscles are divided and the chest is spread open.
• The lung is deflated to expose the ductus arteriosus.
• The ductus arteriosus is tied tightly or clamped in two places, cut between the clamps and tied. The ends are sewn shut to prevent bleeding from the pulmonary artery or the aorta.
• Tubes are left in place to drain fluid. A catheter is left in place to remove air from the chest so the lung can reinflate itself within 24 to 48 hours.
• The muscles are sewn together in layers with strong sutures.
• The skin is closed with sutures or clips, which usually can be removed about 1 week after surgery.

POSSIBLE COMPLICATIONS

• Excessive bleeding
• Surgical-wound infection.
• Nerve injury.

AVERAGE HOSPITAL STAY--7 days.

PROBABLE OUTCOME--Expect complete healing without complications. Allow about 4 weeks for recovery from surgery.

Postoperative Care

† Have the child move and elevate legs often while resting in bed to decrease the likelihood of deep--vein blood clots.

MEDICATION

• Your doctor may prescribe pain relievers. Don't give your child prescription pain medication longer than 4 to 7 days. Use only as much as needed.
• Antibiotics to fight infection.

ACTIVITY

• Avoid vigorous exercise for 6 weeks after surgery.
• Don't let your child ride in a car for 2 weeks after returning from the hospital.

DIET--Clear liquid diet until the gastrointestinal tract functions again. Then provide a well--balanced diet to promote healing.

Call Your Doctor If

† You observe excessive bleeding.

• You observe signs of infection: headache, muscle aches, dizziness or a general ill feeling and fever.
• You observe new symptoms, such as nausea, vomiting, constipation or abdominal swelling.