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Riley Grace: Video-Assisted Thorascopic Repair for PDA

Riley GraceRiley Grace weighed 1 pound 7 ounces when she was born May 31, 2011, to parents Brandi and Steve, more than three months premature at 24 weeks’ gestation. She spent a total of 124 days in the Neonatal Intensive Care Unit (NICU) at Children’s Memorial Hermann Hospital.

Diagnosed with bronchopulmonary dysplasia (BPD), a chronic lung condition that affects babies who are born very early, Riley Grace was placed on a ventilator to support her breathing after delivery. She also had patent ductus arteriosus (PDA), a condition in which a blood vessel called the ductus arteriosus fails to close normally after birth. Her medical team attempted to treat the PDA without surgery, but when the duct grew larger, they made the determination that surgery would give her a better chance at life. 

Infant Surgery for PDA

“PDA results in abnormal blood flow between the aorta and pulmonary artery, two major blood vessels that carry blood from the heart, causing too much blood flow to the lungs,” says pediatric cardiovascular surgeon Michael Hines, M.D., a professor in the department of Pediatric Surgery at The University of Texas Health Science Center (UT Health) Medical School at Houston. “If the PDA is not closed, the infant is at risk of developing heart failure in the case of a large ductus, or infective endocarditis in the case of a small ductus.”

Riley Grace was one of the first pediatric patients in Houston to benefit from PDA repair using video-assisted thorascopic surgery (VATS), a procedure Dr. Hines has performed on more than 500 children during the last 16 years. The benefits to patients can be enormous. By avoiding opening the chest with the large incision used in thoracotomy, children have less pain, fewer respiratory complications, improved function,quicker recovery and a smaller scar, which subsequently lowers the total cost of treatment.

 

PDA Repair Surgery

When Dr. Hines accompanied Riley Grace to the OR on September 13, 15 weeks after she was born,she was still tiny, weighing only about 5.5 pounds. He made four small incisions between 3 and 4 millimeters in size for insertion of surgical instruments and the clip he would use to close the PDA. Ports were placed in the left chest under the armpit and on the back under the shoulder blade. After the successful procedure, Riley Grace was transported back to the NICU to recover. Infants who are not premature or under intensive care for other conditions usually can go home the same day taking only ibuprofen as needed for pain.

“No one is prepared for the challenges you face when your baby is born prematurely,” says Riley Grace’s father Steve, who cares for her while working from home. “Our biggest obstacle was weaning her off the ventilator, a struggle that lasted two months. When you’re on the ventilator that long, you go from having respiratory distress syndrome to chronic lung disease.

“Once we made the decision for surgery, we wanted to choose the least invasive option with the quickest recovery for her,” he says. “Fortunately, Dr. Hines presented us the option of performing the VATS procedure, which turned out to be a huge success. We are grateful to Dr. Hines and his team who were very informative from the initial consultation to the follow-up appointment after discharge. She’s growing into a happy, healthy baby.”

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