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Patent Ductus Arteriosus Patent ductus arteriosus (PDA) results from a failure of the body to close a small blood vessel called the ductus arteriosus. The ductus communicates between the aorta and pulmonary artery when the puppy or kitten is in the uterus. Normally, the ductus closes shut within hours of birth. However, failure of this vessel to close is a congenital defect that results in shunting of blood from the aorta to the pulmonary artery. This shunting of blood usually creates a loud heart murmur that is often characteristic of this congenital defect.An echocardiogram (sonogram of the heart) is beneficial to definitively diagnose a PDA. It is also helpful to perform this procedure to make sure no other congenital defects are present in conjunction with the PDA. An echocardiogram also allows the cardiologist to determine how severe the defect is and what effects it is having on the heart's function. Treatment of a patent ductus arteriosus defect requires surgery. The standard surgical procedure involves open chest surgery by a veterinarian familiar with this procedure. Surgery is usually curative and the patient can lead a normal life after recuperation from surgery. The operation is usually performed when the puppy or kitten is 8 to 20 weeks of age or as young as feasibly possible. There are potential complications with the surgery. Since we are working around the aorta, hemorrhage is a potential complication that can even be life threatening. This is uncommon in the hands of an experienced surgeon. Other potential, but uncommon complications are the recanalization of the vessel after surgery (i.e., the body re-establishes the vessel between the aorta and the pulmonary artery) or postoperative infection. Surgeries are performed with sterile technique and the animals are discharged on antibiotics to help prevent any infection from occurring. Another option for closure of the ductus arteriosus is a procedure that utilizes special coils that are deployed into the ductus via a catheter. A small incision is made in the region of the femoral artery (inside of the hind leg). The catheter is advanced up the femoral artery to the heart via fluoroscopic guidance (video x-ray). The special coils are then carefully placed in the vessel which causes a blood clot to form in the ductus arteriosus. This type of repair is also permanent. Not all dogs with a PDA are candidates for this type of procedure. Dogs under ten pounds are too small for this technique. We also look for certain criteria during an echocardiogram study of the heart prior to deciding to use this technique. Success rates are reported as high as 85-90%. The remaining 10-15% of the dogs still may require traditional thoracic surgery to close the defect. The entire surgery takes 2-3 hours. Painkillers and nerve blocks are used after thoracic surgery to manage any post-operative discomfort. The patient is usually discharged to go home one to two days after the surgery. If any heart medications were initiated prior to the surgery, they are continued for another two to three months. With the coil procedure, the discomfort is limited and painkillers are often not required. Coil patients are usually discharged the day after the procedure. When your pet is discharged, strict exercise restriction will be required for 10 days until the sutures are removed by your veterinarian or us. Leash walking is fine, but vigorous exercise is not recommended. We will also want to recheck a final echocardiogram in 2-3 months to both assure the success of the surgery as well as to evaluate the overall function of the heart after the operation. |
