A 6 week old male Bichon Frise puppy presented with a history of a litter mate that had a loud heart murmur dying acutely the previous week.  Upon examination a grade 3/6 continuous heart murmur was auscultated typical of a Patent Ductus Arteriosus (PDA).  "Water hammer" bounding pulses were also present and an echocardiogram confirmed an uncomplicated PDA.  A PDA is caused by the persistence of fetal circulation which largely bypasses the uninflated lungs in-utero.  Upon birth the suddenly increased oxygen content in the blood from normal respiration causes a spasm of an arterial connection between the main pulmonary artery and the descending aorta, effectively closing the PDA which goes on to scar closed in the first few weeks of life.  If the vascular musculature in the PDA is abnormal, it is not able to properly close, and a PDA results.  If this is not corrected, the puppy typically will develop severe cardiac hypertrophy and progress to congestive heart failure at a young age, often before they reach maturity.  The treatment of choice is closure of the PDA, often accomplished by surgically ligating (tying off) the ductus.

The PDA is clearly seen before starting the dissection. Sutures are used to retract the Vagus and Phrenic nerves out of the operative field and the aorta is retracted dorsally with umbilical tape to aid dissection around the caudal aspect of the ductus.

The PDA has been isolated by bluntly dissecting around the entire vessel and two 1/8 inch umbilical tape ligatures along with a 4 "0" silk suture have been passed around the ductus in preparation for ligation.

The PDA has been ligated. Note the 4 "0" silk transfixation suture and umbilical tape ligatures have been tied occluding the ductus and now need to have thier ends trimmed.

The 4 "0" silk transfixation suture and umbilical tape ligatures have been trimmed. Once the sutures retracting the Vagus and Phrenic nerve and the umbilical tape around the aorta are cut and removed the chest is closed.

A chest tube to aspirate air and fluid post-operativly has been placed and the chest wall closed with 3 layers of sutures. The subcutaneous tissue is now being closed.

The chest has been closed. The skin will be closed with staples and a purse string suture placed around the chest tube.

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The PDA is clearly seen before starting the dissection. Sutures are used to retract the Vagus and Phrenic nerves out of the operative field and the aorta is retracted dorsally with umbilical tape to aid dissection around the caudal aspect of the ductus.