Patent ductus arteriosus (PDA) closure can be done in several ways ranging from medication to surgery and, increasingly, a minimally invasive alternative to surgery that places a tiny plug in the opening.

The ductus arteriosus is a special blood vessel that allows the placenta to supply oxygen to the baby while in the uterus. This ductus arteriosus stops blood from going to the lungs and instead sends blood out to the body after picking up oxygen.

A baby’s first noisy breaths and functioning lungs start the process of closing the blood vessel. If it doesn’t close within a few days, physicians will need to evaluate the patent (open) ductus arteriosus and determine what steps, if any, need to be taken.

The ductus arteriosus tends to stay open more often in preterm babies, but the condition can happen in full-term babies too.

PDA closure is a rapidly advancing repair. Some small PDAs can be left alone and will close by the baby’s first birthday. Other PDA closures may require medication, cardiac catheterization, open surgery or placement of a tiny plug in the blood vessel.

This plug, called the Amplatzer Piccolo Occluder, is an alternative to heart surgery for PDA closure and one of many innovative therapies employed by the specialists at Norton Children’s Heart Institute, affiliated with the UofL School of Medicine.

The Piccolo is threaded through blood vessels through a tiny incision to reach the site of the patent ductus arteriosus. There, an interventional cardiologist puts the pea-sized plug in place and expands it, closing the blood vessel. Eventually, tissue grows over its mesh structure.

The Piccolo is the first Food & Drug Administration-approved minimally invasive PDA closure device for premature babies weighing less than about 4½ pounds.

The specialists at Norton Children’s Heart Institute have a range of options to perform PDA closure depending on the child’s particular condition. Pediatric cardiologists, interventional pediatric cardiologists and pediatric cardiothoracic surgeons discuss each patient and bring their own viewpoints to the treatment plan.

More families in Louisville choose Norton Children’s Heart Institute than any other pediatric heart care provider in the area. The Society of Thoracic Surgeons has rated Norton Children’s Heart Institute’s pediatric heart care among the best in the region.

What Happens During a PDA Closure?

If the Norton Children’s Heart Institute specialists decide closure is needed for a PDA, the team will have everything available to address your child’s needs at Norton Children’s Hospital.

• If your child needs to be sedated (asleep), a specially trained pediatric cardiac anesthesiologist will administer the anesthesia.
• An interventional cardiologist will place a catheter — a long, thin tube — into a large blood vessel. The catheter will then be threaded into the heart.
• The interventional cardiologist can take a picture (called an angiogram) of the PDA and other structures of the heart if needed.
• If the PDA is small, the interventional cardiologist may use a Piccolo device to close the vessel.
• If the PDA is too big or catheterization is not successful, the child may require surgery.

If the Norton Children’s Heart Institute specialists decide the PDA closure requires surgery:

• Your child will need to be sedated (asleep). A specially trained pediatric cardiac anesthesiologist will administer the anesthesia.
• A pediatric cardiothoracic surgeon will make a small incision (cut) between the ribs on the left side of your child’s chest.
• The surgeon will perform the PDA closure by tying off each end of the vessel and dividing it by cutting it between the two ends that were tied off.

Complications and After Care

The risk of complications associated with PDA closure is low. Babies with lung disease from prematurity and those on ventilators prior to surgery may have a complicated recovery related more to their lung disease than the actual operation.

Why Choose Norton Children’s Heart Institute

• Norton Children’s Hospital has been a pioneer in pediatric cardiothoracic surgery, performing Kentucky’s first pediatric heart transplant in 1986 and becoming the second site in the United States to perform an infant heart transplant.
• The American Board of Thoracic Surgery has certified our cardiothoracic surgeons in congenital heart surgery.
• The Adult Congenital Heart Association has accredited Norton Children’s Heart Adult Congenital Heart Disease Program as the only comprehensive care center in Kentucky and Indiana treating adults born with a heart defect.
• More than 17,000 children a year visit Norton Children’s Heart Institute for advanced heart care.
• Norton Children’s Heart Institute has offices across Kentucky and Southern Indiana to bring quality pediatric heart care closer to home.
• The Jennifer Lawrence Cardiac Intensive Care Unit (CICU) at Norton Children’s Hospital is the largest dedicated CICU in Kentucky, equipped with 17 private rooms and the newest technology available for heart care.