15 mo DD with patent ductus arteriosis - should we close?

[numummy2b]

Not sure if anyone has experience of this or similar?

My DD (15 mo) was diagnosed with patent ductus arteriosis at 5 weeks of age - and since then has had 6 monthly ultrasounds at Royal Brompton. The hole is classified as small and hasn't impacted her growth or development. She was born at 42+ weeks through emergency caesarean.

The consultant is monitoring her every 6 months but is currently of the opinion we should 'wait and see'... But I'm recently wondering if we should just go ahead and ask them to surgically close the PDA given it is highly unlikely to close of its own accord after 3 mo.

My main concern is that I expect she will be a very sporty child (as her father and I are) and I would hate for this to hold her back or impact on her health longer term. If we don't treat the PDA I am aware there is an increased risk of heart infection and that there can be longer term issues but not usually with smaller PDAs....

Does anyone have experience of this?

Thanks!

The main thing your consultant will be considering is that although the PDA is unlikely to close completely after 3 months old, it's size relative to the heart's total size becomes smaller ( ie the heart gets bigger the PDA stays the same) thus the effect on blood flow reduces as the child grows.

So you are weighing up the potential risk of an operation against the potential risk of a long term PDA. A small PDA gives an increased long term risk of infection that is usually managed with antibiotics when the risk is increased (minor operations, dental work etc.), an operation gives a high short term risk of complications and infection.

A small PDA can be closed at any age.
It is unlikely that it will cause your DD to under-perform at sport, and if it did the option to close it is still there and as she grows the operation becomes lower risk.

The choice is, of course yours, but with close monitoring and all the data that the Royal Brompton have, I would not be worrying about closing it just now unless they recommended.

Hope you find enough information to help you make your decision.

How do they close a PDA? Is it open heart heart or catheter?

Usually a catheter based procedure these days. Open procedures are usually reserved for failed catheter closure or for children/adults with other anomalies or anatomical variations or prem babies who are too small for catheter.

We have 15m twins. DTS was diagnosed with a severe PDA at 7 m. He had many of the typical symptoms (heart murmur, failure to thrive, pale, enlarged heart etc) DTD was scanned also and a small PDA was detected but no adverse symptoms. Pretty sure that DTD would not have been diagnosed if it wasnt for DTS being checked out which makes me wonder how many undiagnosed minor PDAs are out there....

DTS was operated on at Great Ormond Street; they booked him in v quickly which was indicative of the severity of the PDA. An occlusion device was inserted via catheter. It should have been a day procedure but there were complications, he lost some blood so stayed in overnight for a transfusion. We were discharged the next day and he quickly improved (colour, heart rate, feeding etc). So it went really well but was still very traumatic for us and for him.

We are getting both twins checked every 6m now. DTS is doing fine, PDA is closed. DTD still has a small PDA but has no adverse symptoms so no need to operate. To quote the specialist:" the reasons not to operate on her are the opposite of the reasons why we urgently operated on him".

Our advice for what it's worth: trust the specialist advice, keep monitoring for physiological symptoms, can always operate in a year or so and the bigger your DD is, the easier the procedure will be. The risks of anything going wrong with the operation especially via catheter are very small but not zero and this becomes very real when you are signing the informed consent and watching your DTS go under for the op.....

glad your twins are thriving after what must have been a very frightening time for you all.

Thanks for your message foolonthehill. DTS is indeed thriving, unfortunately has lots of energy at 3 am!