Penutupan Peranti Ductus Arteriosus (PDA) Paten

Who Needs a PDA Device Closure?

Closure of PDA devices is suggested in patients who have:

• A moderate to large PDA causes significant left-to-right shunting.
• Symptoms of poor feeding, increased respiratory rate, failure to thrive, or respiratory infections.
• An enlarged heart or increased pulmonary blood flow on echocardiography.
• Identified PDA in adults who develop heart failure or pulmonary hypertension.
• Hemodynamically significant PDA in premature infants that persists with medical therapy.

Small PDA, without symptoms or hemodynamic disturbance, may not need closure. However, it may be appropriate to follow up regularly.

Types of PDA Device Closure Procedures

PDA is ideally closed using surgical or catheter-based interventions. In most instances, catheter-based closure using a device is preferred.

Catheter-Based PDA Device Closure

This closure is performed via a catheter inserted into the vascular system (typically the femoral vein or artery). The PDA is then closed by deploying a closure device (coil or occluder) to complete the procedure.

Surgical Ligation

This is an open surgical approach and is usually reserved for very small premature neonates or when catheter closure is not possible. It consists of tying the PDA closed through a small incision in the chest wall.

Overall, catheter-based PDA device closure is lebih invasif minimum, highly successful, and results in lebih cepat recovery compared to the surgical approach.

Penilaian dan Diagnostik Pra-Rawatan

Before the PDA device closure, several investigations will be completed to substantiate the diagnosis, and patient profile, and kepada menilai khususnya suitability for catheter-based treatment.

Typical previous investigations during the approach of PDA closure are:

• Echocardiogram
• X-Ray dada 
• Electrocardiogram (ECG).
• Cardiac Catheterisation (as required) 
• Ujian darah

On occasions, the PDA will require urgent closure, where there is a prolonged need for the patient to be in contact with a mechanical ventilator.  

Pemilihan dan Perancangan Prosedur

The selection of the appropriate closure method and device depends on:

• Size and shape of the PDA
• Umur dan berat pesakit
• Presence of associated heart defects
• Degree of left-to-right shunt and pulmonary hypertension
• Suitability for catheter access

Pilihan Peranti:

• Gegelung: Used for small PDAs
• Occluder Devices: Such as the Amplatzer duct occluder, preferred for moderate to large PDAs

Planning includes detailed echocardiographic measurements and a discussion of risks, benefits, and alternatives with the family.

PDA Device Closure Procedure

Step-by-step process of PDA device closure:

1. Anesthesia - Ia biasanya dilakukan with general anesthesia, although local anesthesia may be used in some cases with sedation. 
2. Catheter Insertion - The catheter is then inserted through a vein in the groin. It is then guided to the heart and the location of the PDA.                                                                
3. Angiography - Angiography, with the help of a contrast dye, helps visualize the PDA and surrounding structures. The optimal device size and its placement can thus be determined. 
4. Penyerahan Peranti - An occluder or coil is loaded into the catheter and advanced toward the PDA. 
5. Device Release - Once the device is in the kanan position, it is released from the catheter. 
6. Pengesahan - The surgeon confirms the proper placement of the device and the closure of the PDA. Residual shunts are then checked, and the device may be replaced or repositioned if required. 
7. Pembuangan Kateter - Post confirmation of the closure, the catheter is removed to complete the process. 

The procedure typically takes 30–90 minutes, and most patients are discharged within 24–48 hours.

Risks & Potential Complications of PDA Device Closure

PDA device closure is considered safe, Tetapi as with all medical procedures, certain risks exist, including the following:

• Residual shunting (incomplete closure)
• Device embolization or migration
• Kecederaan saluran darah
• Aritmia
• Reaksi alergi terhadap pewarna kontras
• Infection (rare)

Serious complications are uncommon and can typically be managed promptly by experienced cardiologists.

What to Expect After PDA Device Closure?

Post-procedure recovery is typically quick, with minimal discomfort.

Pemulihan Segera

• Monitoring in a recovery unit for several hours.
• Hospital stay of 1–2 days in most cases.
• Mild groin discomfort or bruising at the catheter insertion site.

Penjagaan Selepas Prosedur

• Antibiotic prophylaxis to prevent endocarditis for at least 6 months.
• Activity restrictions for a few days post-procedure.
• Follow-up echocardiography to ensure device stability and complete closure.

Pemulihan Selepas Rawatan & Penjagaan Jangka Panjang

Most patients return to normal life quickly after PDA device closure. Long-term care includes the following:

• Periodic cardiac evaluations to monitor heart function and device integrity.
• Blood pressure monitoring, particularly in older patients.
• Continuing good oral hygiene to prevent endocarditis.
• Avoid heavy physical activity for 1–2 weeks post-procedure.

The majority of patients experience complete recovery with no long-term limitations. PDA device closure significantly reduces the risk of future complications such as pulmonary hypertension and heart failure.

PDA Device Closure Success Rate in India

The success rates for PDA device closure in India are excellent and comparable to international benchmarks.

• Immediate Closure Success: Over 95% across most centers.
• Long-Term Closure Success: Over 99% with minimal residual flow.
• Complication Rates: Less than 1% for major complications.
• Pemulihan: Most patients return to biasa activities within hari.

Timely intervention ensures the prevention of serious complications and allows for a normal quality of life.

Why Choose India for PDA Device Closure?

India is one of the most preferred global destinations for affordable, high-quality pediatric and adult cardiac care.

• Highly experienced interventional cardiologists and pediatric cardiac teams.
• Access to the latest device closure technologies like the Amplatzer Piccolo and the Occlutech PDA Occluder. 
• Advanced catheterization labs are equipped for minimally invasive heart procedures.
• Affordable PDA closure packages compared to Western countries.
• Dedicated cardiac care units for newborns, children, and adults.
• Minimal waiting times and excellent medical tourism menyokong.

Documents Required for Patients Traveling to India for PDA Device Closure

For international patients looking for PDA device closure in India, it is necessary to present certain documentation to have a smooth medical journey. These include:

• Pasport sah: Sah untuk sekurang-kurangnya enam bulan selepas tarikh perjalanan anda.
• Visa Perubatan (Visa M): Diberikan oleh Kedutaan/Konsulat India atas alasan perubatan.
• Surat Jemputan dari Hospital India: Surat rasmi yang menerangkan perjalanan rawatan dan berapa lama ia akan bertahan.
• Rekod Perubatan Terkini: X-ray, MRI, ujian darah, dan nota rujukan oleh doktor di negara asal.
• Borang Permohonan Visa yang lengkap: Dengan gambar berukuran pasport mengikut spesifikasi.
• Bukti Cara: Penyata bank bertarikh dalam beberapa bulan lalu atau insurans kesihatan.
• Visa Atendan Perubatan: Diperlukan untuk teman atau penjaga yang bepergian dengan pesakit.

Adalah dinasihatkan untuk merujuk kepada konsulat India atau fasilitator perubatan anda untuk mendapatkan maklumat terkini dan bantuan dengan dokumentasi.

Top PDA Device Closure Specialists in India

Here are some of the leading specialists in India for PDA device closure. 

1. Krishna S Iyer, Institut Jantung Pengiring Fortis, New Delhi
2. Rajesh Sharma, Hospital Jaypee, Noida
3. Dr Suresh Joshi, Hospital & Pusat Penyelidikan Jaslok, Mumbai
4. Dr KR Balakrishnan, MGM Healthcare, Chennai
5. Devi Prasad Shetty, Kesihatan Narayana, Bangalore

Best Hospitals for PDA Device Closure in India

Here are some of the top hospitals for PDA device closure di India. 

1. Institut Jantung Fortis Escorts, New Delhi
2. Hospital Pakar Super Nanavati Max, Mumbai
3. Hospital Apollo, Chennai
4. Medanta - The Medicity, Gurgaon
5. Hospital Jaslok, Mumbai

Soalan Lazim (Soalan Lazim)

Is the PDA device closure painful?

The procedure itself is not painful, as it is performed under sedation or general anesthesia. Mild discomfort at the catheter site may occur post-procedure.

How soon can a patient return to normal activities?

Most patients resume light activities within a few days and can return to full activities within 1–2 weeks.

Can PDA close on its own?

Small PDAs in premature infants may close spontaneously. Larger PDAs usually require medical or interventional treatment.

What happens if PDA is not treated?

Untreated PDA can lead to serious complications, including heart failure, pulmonary hypertension, and an increased risk of infections.

Are there long-term risks after device closure?

Long-term risks are minimal. Most patients require periodic monitoring but live healthy, active lives after successful closure.