Patent Ductus Arteriosus (PDA)

Brenner Children’s Hospital is the only children’s hospital in North Carolina to offer a better technique to fix a common childhood heart defect. The outpatient procedure – which requires only three or four small incisions in the chest – replaces major surgery to make the repair and correct the condition known as patent ductus arteriosus (PDA). It is offered at only a handful of hospitals in the United States. Dr. Michael Hines, a pediatric heart surgeon, has performed the procedure at Brenner Children’s Hospital since 1995.

The surgery closes a channel, called the ductus arteriosus, between the two major vessels that leave the heart. During fetal development, the channel allows blood to bypass the lungs – which aren’t being used – and go to the rest of the body. After birth, when the baby must use the lungs to take in oxygen, the channel normally closes. In many premature infants, the channel remains open and causes excess fluid in the lungs.

“If the channel is large, it allows excessive blood flow through the lungs and back into the heart unnecessarily and the result is heart failure,” said Hines. “If the channel is smaller, then the child is at risk for getting endocarditis, an infection of the ductus or pulmonary artery, and would need to take antibiotics before having a routine procedure such as dental surgery to help prevent this infection as long as the ductus is open.”

The defect affects about 1 in 2,000 children in the United States. Often it can be corrected with medication, but surgery is recommended when medication does not close the vessel.

For the outpatient procedure, Hines inserts a tiny camera, called a thoracoscope, and instruments through small incisions in the chest. He uses a metal clip to close the channel. The clip lasts a lifetime and the surgery does not have to be repeated.

“The child spends a few hours in the hospital and then goes home the same day,” said Hines.  Hines is the only cardiothoracic surgeon in the Southeast who uses this outpatient procedure to close the defect.