What is Transcatheter Closure of Patent Ductus Arteriosus

The ductus arteriosus is a blood vessel in the heart that normally closes soon after birth. Transcatheter closure is a procedure to close off the ductus arteriosus if it stays open (patent) after birth. During the procedure, a thin, flexible tube (catheter) is used to place a closure device in the blood vessel.

Tell a health care provider about:

• Any allergies your child has.
• All medicines your child is taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems your child or family members have had with the use of anesthetic medicines.
• Any blood disorders your child has.
• Any surgeries your child has had.
• Any medical conditions your child has.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Severe bleeding.
• Damage to other structures or organs, especially a heart chamber or valve.
• Infection.
• Movement of the closure device after placement.
• Disturbance of blood flow.
• Blood clots.
• Allergic reaction to medicines.

What happens before the procedure?

Staying hydrated

Follow instructions from your child’s health care provider about hydration, which may include:

• Up to 2 hours before the procedure – your child may continue to drink clear liquids, such as water or clear fruit juice.

Eating and drinking restrictions

Follow instructions from your child’s health care provider about eating and drinking, which may include:

• 8 hours before the procedure – have your child stop eating foods.
• 6 hours before the procedure – have your child stop drinking formula or milk.
• 4 hours before the procedure – stop giving your child breast milk.
• 2 hours before the procedure – have your child stop drinking clear liquids.

Medicines

Ask your child’s health care provider about:

• Changing or stopping your child’s normal medicines. This is especially important if your child is taking diabetes medicines or blood thinners.

What happens during the procedure?

• To reduce your child’s risk of infection:
  • Your child’s health care team will wash or sanitize their hands.
  • Your child’s incision area will be washed with soap.
• An IV tube will be inserted into one of your child’s veins. Fluids and medicine will flow through the tube.
• Your child will be given one or more of the following:
  • A medicine to help him or her relax (sedative).
  • A medicine to make him or her fall asleep (general anesthetic).
  • A medicine to numb an area of the groin (local anesthetic).
• A tube may be placed down your child’s throat to help with breathing.
• A small incision will be made, usually in the groin. In some situations, the incision may be made in the arm instead.
• A catheter will be inserted into a blood vessel in the incision. It will be guided to the patent ductus arteriosus.
• A closure device will be guided through the catheter and placed in the patent ductus arteriosus.
• The health care provider will check to make sure the device is working.
• The catheter will be removed.
• The incision may be closed with stitches (sutures) or skin adhesive, as needed.
• Bandages (dressings) will be placed on the incision site.

What happens after the procedure?

• Your child will wake up in a recovery area.
• Your child’s blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored often until the medicines he or she was given have worn off.
• Your child’s skin temperature near the incision site will be monitored.
• Your child may need to keep his or her leg straight for as long as directed by his or her health care provider.
• Your child’s health care provider may do a test called an echocardiogram to check the success of the procedure.
• If your child is of driving age, do not let him or her drive for 24 hours if he or she was given a sedative.

Summary

• Transcatheter closure is a procedure to close off the ductus arteriosus if it stays open (patent) after birth.
• During the procedure, a thin, flexible tube (catheter) is used to place a closure device in the blood vessel.
• Your child may need to keep his or her leg straight for as long as directed by his or her health care provider.

Transcatheter Closure of Patent Ductus Arteriosus, Pediatric, Care After

This sheet gives you information about how to care for your child after the procedure. Your child’s health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common for your child to have tenderness at the incision site, most commonly in the upper leg area near the groin.

Follow these instructions at home:

Incision care

• Follow instructions from your child’s health care provider about how to take care of your child’s incision. Make sure you:
  • Wash your hands with soap and water before you change your child’s bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your child’s dressing as told by your health care provider.
  • Leave stitches (sutures) or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
• Check your child’s incision area every day for signs of infection. Check for:
  • Redness, swelling, or pain.
  • Fluid or blood.
  • Warmth.
  • Pus or a bad smell.
• Do not allow your child to soak in water, such as by sitting in a bathtub or swimming, until his or her health care provider approves. Your child may shower or be given sponge baths.

Medicines

• Give over-the-counter and prescription medicines only as told by your child’s health care provider.
• Do not give your child aspirin unless instructed to do so by your child’s health care provider.
• If your child is of driving age:
  • Do not let your child drive for 24 hours if he or she was given a medicine to help him or her relax (sedative).
  • Do not let your child drive or use heavy machinery while taking prescription pain medicine.

General instructions

• Limit your child’s activity as directed by your child’s health care provider.
• Allow your child to return to school or daycare when directed by your child’s health care provider.
• Keep all follow-up visits as told by your child’s health care provider. This is important.

Contact a health care provider if:

• Your child feels pain at the incision site.
• There is redness, swelling, or pain around your child’s incision.
• There is fluid or blood coming from your child’s incision.
• Your child’s incision feels warm to the touch.
• Your child has pus or a bad smell coming from her or his incision.
• Your child has a fever.

Get help right away if:

• Your child who is younger than 3 months has a fever of 100°F (38°C) or higher.
• One foot or leg is cooler or has a different color than the other.
• Your child has trouble breathing.

Summary

• After the procedure, it is common for your child to have tenderness at the incision site, most commonly in the upper leg area near the groin.
• Check your child’s incision area every day for signs of infection.
• Get help right away if one foot or leg is cooler or has a different color than the other.