Coil Occlusion For Patent Ductus Arteriosus Closure In Children

What you should know

• Patent Ductus Arteriosus (r-teer-e-O-sus) coil occlusion (o-CLUE-shun) is also called "PDA coil occlusion" or "PDA closure". It is done to close your child's PDA. PDA is a channel or path that connects 2 large arteries that come out of the top of the heart. Unborn babies need this channel. After a baby is born, the PDA should naturally close. After birth, your child does not need a PDA. A PDA causes your baby's heart and lungs to work harder than they should. This is because blood that should be pumped out to the body leaks back into the lungs and heart. In time, this "circling" of blood may cause congestive (kun-JES-tiv) heart failure (heart wears out) and lung damage.
  
  
• PDA coil closure is done during a heart catheterization (kath-uh-ter-ih-ZA-shun) or "heart cath". A heart cath is a procedure in which catheters (long, thin, bendable tubes) are gently threaded (guided) into your child's heart. Your child's caregivers push 1 or more tiny metal coils through a catheter and plug them into the PDA. If the PDA coil closes your child's PDA, he may not need surgery. Your child may go home the same day or may stay in the hospital after the PDA is closed.

Care Agreement

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's caregivers to decide what care you want for your child.

Risks

• There are risks in putting catheters in the blood vessels. This could cause bleeding, a bruise, and soreness around the place where a catheter went in. Your child could bleed and need a blood transfusion (trans-FEW-shun) or surgery to repair the hole. Your child could get air bubbles or a blood clot from the heart cath or device. Air bubbles could give your child a stroke. Blood clots may go to your child's lungs or brain and cause a stroke. The clots may go to your child's arm or leg and stop the blood flow. Fluid could build up in your child's lungs and cause trouble breathing.
  
  
• Your child could get a collapsed lung or an infection. Your child could have an allergic (uh-LER-jik) reaction or kidney problems from the dye used during the procedure. A blood clot may form on the coil that was used to close the PDA. The coil could move out of place. Then your child may need surgery to remove the coil and repair the PDA. Caregivers will watch your child closely for these problems.
  
  
• If your child does not have his PDA closed, your child's health condition could get worse. Your child's heart could fail (wear out), his lungs could be damaged, and your child could die. Call your child's caregiver if you are worried or have questions about your child's PDA, medicine, or care.

Getting Ready

The Week Before Your Child's PDA Closure:

• Talk about medicines and allergies with your child's caregiver.
  
  
  • Talk to your child's caregiver about all your child's medicines. Tell the caregiver about all prescriptions, over-the-counter medicines, vitamins, and herbs that you give your child. Your child's caregiver may tell you not to give your child certain medicines before the PDA closure. Do not stop giving your child any medicines without first asking your child's caregiver.
    
    
  • A dye is a liquid that will be used during your child's PDA closure. It helps the parts of the heart to show up better. People who are allergic to shellfish (lobster, crab, or shrimp) may also be allergic to this dye. Tell your child's caregiver if your child is allergic to any of these.
    
    
  • Make sure you understand clearly about the PDA closure and why it is being done. If you do not understand, write down your questions and ask your child's caregivers. Tell caregivers about any long-term health problems your child has.
  
  
• Take your child for tests. Your child may need an echocardiogram, EKG, or chest x-ray before his surgery. Ask your child's caregiver for information about these and other tests he may need. Write down the date, time, and location of each test.
  
  
• Arrange family support.
  
  
  • If your child is old enough to understand, talk to him about the PDA closure. Talking about it may decrease your child's fear or anxious feelings. Ask caregivers about ways to help your child get ready for the procedure.
    
    
  • Plan to be at the hospital during and after your child's PDA closure. If this is not possible, ask a family member to stay while you cannot be there. This is especially important after the PDA closure. Your child will need to lie flat. He will need to keep the leg or place that had the catheter in it very still. Caregivers may ask you to help your child lie flat and still.

The Day Before Your Child's PDA Closure:

Ask caregivers about directions for eating and drinking.

The Day Of Your Child's PDA Closure:

• Write down the date, time, and location of your child's surgery.
  
  
• Ask your child's caregivers before giving your child his medicines today. Your child may not be allowed to take them. These medicines include insulin, diabetic pills, or heart pills. Bring a list of your child's medicines or the pill bottles with you to the hospital.
  
  
• Have your child wear his glasses. If your child wears contact lenses regularly, he should not wear them the day of the PDA closure. Have him wear his glasses instead. Leave your child's jewelry at home.
  
  
• Bring your child's personal belongings. If your child is staying in the hospital before or after the PDA closure, bring his personal belongings. These include your child's pajamas and bathrobe, toothbrush, hairbrush, and slippers. Bring an object that is special to your child, like a favorite toy or blanket.
  
  
• Have your child take a full bath or shower before the heart cath. Your child should wash his hair and body well. He may not be able to fully bathe until a few days after the procedure. Remove your child's nail polish.
  
  
• Talk to the anesthesiologist (an-iss-thee-z-ALL-o-jist). An anesthesiologist may talk to you and your child before your child's PDA closure. This is the caregiver who gives your child medicine to keep him asleep and comfortable during the PDA closure.
  
  
• Make sure you have signed an informed consent. You or a close family member may be asked to sign a legal piece of paper (consent form). It gives your child's caregivers permission to do a PDA closure. Be sure all your questions have been answered before you sign the form.

Treatment

What Will Happen:

• Your child will change into a hospital gown. Your child will get medicine to make him relaxed and drowsy. He will be taken on a stretcher to the room where the PDA closure will be done. Your child will get an IV and may get more medicine to make him go to sleep. Once your child is asleep, catheters will be put into the blood vessels in your child's groin, neck, or arm. The catheters are gently threaded (pushed) through the blood vessels and heart.
  
  
• Your child's caregivers may use dye and x-rays during the PDA closure. Caregivers may use these before and after the procedure to look at your child's PDA. During the procedure, caregivers will use 1 or more tiny coils to plug your child's PDA closed. The catheters will be removed after the PDA is closed. Caregivers will put pressure on the area where the catheters came out. This is to stop the bleeding. A pressure bag or bandage may be put in place for 2 or more hours. Your child may have stitches to stop the bleeding. It is very important for your child to lie flat and to keep the leg or place that had the catheter very still. This is to prevent bleeding.

After Your Child's PDA Closure:

• Your child will be taken to a recovery area. Then, your child may be taken to a hospital unit or room, or he may go home. Your child will need to lie flat and keep his leg or arm still for about 4 hours. Your child may feel like napping or feel very sleepy for a few hours after the PDA closure. Bring favorite books, electronic games, or videotapes that your child enjoys. If your child is very young, bring a favorite toy or blanket for him. These may help him to lie still when he fully awake after the procedure.
  
  
• Caregivers will check your child's vital signs (pulse, blood pressure, and breathing) every 15 minutes for 1 to 2 hours. The pulses in your child's feet or wrists will also be checked often. Your child's toes and fingers will be checked to see if they are warm. Do not let your child get out of bed until his caregiver says it is OK.

Waiting Room:

This is a room where you and your family can wait until your child is ready for visitors after the PDA closure. Your child's caregivers can find you there to let you know how the PDA closure went. If you leave the hospital, leave a phone number where you can be reached.

Contact a caregiver if

• Your child cannot come to the PDA closure appointment on time.
  
  
• You have questions or concerns about your child's PDA closure.
  
  
• Your child has a fever.
  
  
• Your child's heart problems get worse.