CPT® Code 33820

1. Indications

The repair of patent ductus arteriosus (PDA) is indicated in patients who exhibit symptoms or conditions associated with the failure of the ductus arteriosus to close after birth. These indications may include:

• Heart Failure Patients may experience signs of heart failure due to the increased workload on the heart caused by abnormal blood flow.
• Respiratory Distress Infants and children may present with difficulty breathing or other respiratory issues as a result of pulmonary overcirculation.
• Failure to Thrive Children may show inadequate growth or weight gain due to the effects of PDA on overall health.
• Continuous Murmur A characteristic continuous heart murmur may be detected during a physical examination, indicating the presence of PDA.

2. Procedure

The procedure for the repair of patent ductus arteriosus by ligation involves several critical steps:

• Step 1: Anesthesia and Positioning The patient is placed under general anesthesia to ensure comfort and immobility during the procedure. The patient is then positioned appropriately, typically in a lateral decubitus position, to facilitate access to the thoracic cavity.
• Step 2: Thoracotomy A posterolateral thoracotomy incision is made to access the heart and the ductus arteriosus. This incision allows the surgeon to visualize and manipulate the structures surrounding the ductus.
• Step 3: Identification of the Ductus Arteriosus Once the thoracotomy is performed, the surgeon carefully identifies the patent ductus arteriosus. This step is crucial for ensuring that the correct vessel is targeted for repair.
• Step 4: Ligation of the Ductus The ductus arteriosus is then suture ligated, which involves tying off the vessel to prevent blood flow. Alternatively, clips may be used to achieve closure. This step is essential to eliminate the abnormal connection between the aorta and pulmonary artery.
• Step 5: Division (if applicable) In cases where the ductus is to be divided, the surgeon will cut the ductus arteriosus after ligation. This step is performed based on the specific clinical scenario and the age of the patient.
• Step 6: Closure of the Thoracotomy After the ductus has been ligated and/or divided, the thoracotomy incision is closed in layers, ensuring proper healing and minimizing complications.

3. Post-Procedure

Post-procedure care for patients who have undergone repair of patent ductus arteriosus includes monitoring for any complications such as bleeding, infection, or respiratory distress. Patients are typically observed in a recovery area until they are stable. Pain management is provided as needed, and the healthcare team will monitor vital signs closely. Follow-up care is essential to assess the patient's recovery and ensure that the ductus has been successfully closed. Additional imaging studies may be performed to confirm the absence of residual shunting. The expected recovery time varies based on the patient's age and overall health, but most patients can resume normal activities within a few weeks, depending on their individual circumstances.