A Patent ductus arteriosus (PDA) is a vascular communication typically located between the proximal descending aorta and the main pumonary artery. This results in a left to right shunt with increased pulmonary blood flow and pulmonary hypertension if left untreated. Indomethacin can be administered to infants with PDAs to promote closure, but surgical intervention is often necessary when NSAIDs are contraindicated.
The surgcial procedure is typically performed via a left thoracotomy and cardiopulmonary bypass is not necessary. Care must be taken during surgical dissection, however, because the left vagus nerve travels close to the region of interest, giving off the recurrent laryngeal branch in front of the aortic arch. This branch winds around the descending aorta before ascending behind the ductus to the trachea. Postoperative stridor or hoarseness should alert the anesthesiologist to potential recurrent laryngeal nerve injury.