Patent Ductus Arteriosus

Heart defect present at birth

Patent ductus arteriosus (PDA) is a type of heart defect present at birth (called congenital heart disease). Before birth, the ductus arteriosus allows blood to bypass the baby’s lungs. Once the baby is born and begins to breathe air, the ductus arteriosus is not needed and it usually closes up within a few days. If it remains open (patent), there will be abnormal blood circulation between the heart and lungs.

Patent ductus arteriosus is more common in premature babies, and affects girls more often than boys. Also, babies with other types of congenital heart defects often have a PDA. About 3,000 babies are diagnosed with PDA each year in the United States. The cause of patent ductus arteriosus is unknown.

Symptoms

A small patent ductus arteriosus may not cause any symptoms. A large PDA may cause symptoms such as:

• sweating with crying or playing
• shortness of breath or fast breathing
• fast heart rate
• poor eating and poor growth
• tiring easily

Diagnosis

If patent ductus arteriosus is present, a pediatrician may hear an abnormal heart sound (heart murmur) when listening to the baby’s heart with a stethoscope. Premature babies may not have a heart murmur but may have other symptoms such as fast breathing or problems with feeding. A small PDA may not be diagnosed until the child is older.

If the doctor suspects a heart defect, the baby will be referred to a children’s heart specialist (called pediatric cardiologist). The most important test a cardiologist will do is an ultrasound of the heart (called echocardiogram). This lets the cardiologist look at the structures in and around the heart, so any other heart defects present could be diagnosed as well. A chest x-ray is used to look at the condition of the baby’s heart and lungs.

Treatment

Treatment of patent ductus arteriosus focuses on closing the vessel to prevent complications. Small PDAs sometimes close without treatment. Treatment to close the PDA can be:

• medicine – indomethacin or ibuprofen
• by catheter – a long flexible tube called a catheter is inserted into a blood vessel in the groin and threaded up to the heart. At the end of the catheter is a small plug or coil that is placed in the ductus arteriosus to block the blood flow through it.
• by surgery – an incision is made in the side of the chest and a heart surgeon uses stitches or puts a metal clip on the ductus arteriosus to close it off.

Closing a PDA using a catheter is often done on an outpatient basis and does not require admission to the hospital. Closing the PDA by surgery requires general anesthesia so the child is admitted to the hospital. Most children go home 2 days after the surgery.

_Sources:

"Patent Ductus Arteriosus." Heart & Vascular Diseases. Dec 2007. National Heart Lung and Blood Institute. 11 Nov 2008.

Zieve, David. "Patent ductus arteriosus." MedlinePlus Medical Encyclopedia. 10 Dec 2007. U.S. National Library of Medicine. 11 Nov 2008.