Patent Ductus Arteriosus (PDA): When to Close and How

For TGA with VSD and LVOT obstruction, these kids essentially have pulmonary stenosis with a VSD, and timing depends on the kid's oxygen saturation — they will need a Rastelli or a Nikaidoh operation, both requiring an implant, and the intent is to give the biggest implant possible since a smaller implant means an earlier return for a change. If saturations are above 75% and the kid is growing and doing well, they can wait and have surgery at around one year of age; if saturations are less than 75% with significant failure to thrive, they should come for surgery at any age or weight. On late presenters: we are also a resource-limited country — four or five surgeons doing this work for half of India — and face the same problem of kids coming late every day. My suggestion is education programmes, including pulse oximeter screening at birth, 1 month, and 6 months, referring for an echo early if abnormal. Late-presenting PDAs and cyanotic conditions apart from TGA are usually still operable, even if at slightly higher risk, but VSD shunt lesions can become inoperable if too late — however, even when a kid looks clinically inoperable, we always offer a cardiac catheterisation to confirm, since a significant proportion will still turn out to be operable, if high risk. And even an inoperable VSD child, with good, appropriately timed medical management (diuretics, pulmonary vasodilators), can still survive 25–35 years, whereas without that care they will die much earlier.

Approximately 5,500 USD.

As soon as it is diagnosed, regardless of the child's age or weight, since the mortality risk of closure is very low compared with the risk of ongoing heart failure symptoms.

Yes. If heart failure symptoms are absent or well controlled with medication, device closure can be planned for around 3 months of age.

A condition where the ductus, a normal fetal blood vessel connecting the aorta and pulmonary artery, fails to close after birth, causing a left-to-right shunt that can lead to heart failure symptoms, failure to thrive, and shortness of breath.