Patent ductus arteriosus (PDA) is a heart defect found in the days or weeks after birth. The ductus arteriosus is a normal part of fetal blood circulation. All babies are born with this opening between the aorta and the pulmonary artery. But it usually closes on its own shortly after birth. If it stays open, it is called patent ductus arteriosus. With PDA, extra blood flows to the lungs. The blood vessels and the lungs have to work much harder to handle the extra blood.
PDA occurs twice as often in girls as in boys.Doctors don't know exactly why PDA occurs. It is more common in babies born prematurely. PDA can also occur along with other heart defects.
The size of the opening between the aorta and the pulmonary artery will affect symptoms. If your baby has a small opening, he or she may not have symptoms. If your baby has a larger opening, he or she may have symptoms. The following are the most common symptoms of PDA:
- Bluish skin from not getting enough oxygen (cyanosis)
- Very tired
- Fast or hard breathing
- Trouble feeding, or tiredness while feeding
- Poor weight gain
- In older children, trouble doing activities
The symptoms of PDA can be like other health conditions. Make sure your child sees his or her healthcare provider for a diagnosis.
The healthcare provider will ask about your baby’s symptoms and health history. He or she will give your baby a physical exam. The provider may have heard a heart murmur or found other symptoms during an exam. The provider may refer your baby to a pediatric cardiologist. This is a doctor with special training to diagnose and treat heart problems in children.
The cardiologist will also examine your baby, and listen to his or her heart and lungs. The details about the heart murmur will help the provider make the diagnosis. Your baby may need tests, such as:
- Chest X-ray. A chest X-ray may show an enlarged heart and lung changes in a baby with PDA.
- Electrocardiogram (ECG). An ECG checks the electrical activity of the heart. It shows abnormal rhythms (arrhythmias) and heart muscle stress.
- Echocardiogram (echo). An echo uses sound waves to make a moving picture of the heart and heart valves. An echo shows the pattern of blood flow through the PDA. It also shows how large the opening is, as well as how much blood is passing through it. An echo is the most common way that a PDA is diagnosed.
- Cardiac catheterization. For this test, your baby will be given medicine to relax (sedation). The healthcare provider will put thin, flexible tube (catheter) into a blood vessel in the groin. He or she will guide it through the blood vessel to the heart. The heart is checked, including measuring, blood pressure and oxygen in the 4 chambers of the heart. The pulmonary artery and aorta are also checked. Contrast dye may be injected so the provider can more clearly see the structures inside the heart.
Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.
A small patent ductus arteriosus may close on its own as your child grows. A PDA that causes symptoms will need to be treated with medicine or surgery. The cardiologist will check periodically to see whether the PDA is closing on its own. If a PDA does not close, it will be fixed to prevent lung problems. Treatment may include the following.
Your baby may need medicines help the heart work better.
- In premature infants, the medicine indomethacin may help close the PDA. It is given by IV (intravenously). Indomethacin stimulates the muscles inside the PDA to tighten. This closes the connection. Your child's cardiologist can answer any questions you may have about this treatment.
- Some babies may need to medicines to help the heart and lungs work better. Sometimes a baby may need medicines such as diuretics. Diuretics help the kidneys remove extra fluid from the body. This may be needed when the heart is not working well
Most infants with PDA eat and grow normally. Some premature infants or those infants with large PDAs may become tired when feeding. They may not be able to eat enough to gain weight. Nutrition choices include:
- High-calorie supplements. Special nutritional supplements may be added to formula or pumped breastmilk to increase the number of calories. Your baby can drink less and still have enough calories to grow properly.
- Supplemental tube feedings. Supplemental feedings are given through a small, flexible tube. The tube passes through the nose, down the esophagus, and into the stomach. The feedings can either be added to or take the place of bottle-feedings. Infants who can drink part of their bottles, but not all, may be fed the rest through the feeding tube. Infants who are too tired to bottle-feed may get all of their formula or breastmilk through the feeding tube.
Cardiac catheterizationClosure of the PDA can be done using cardiac catheterization. Metal mesh coils or blocking devices can be put in the PDA. This is usually reserved for beyond infancy and for those whose PDA is not very large. Newer magnetic resonance imaging (MRI) compatible coils are now available that allow the child to have an MRI if needed. Older coils made of stainless steel were not compatible with MRIs.
Surgery can close PDAs. Surgical closure is usually advised for babies younger than 6 months of age who have large defects and who have symptoms such as poor weight gain and fast breathing. For babies who do not have symptoms, any surgery may be delayed until after 6 to 12 months of age. Your child's cardiologist will recommend when the surgery should be done.
The surgery is done under general anesthesia so you child will be asleep. It involves closing the PDA with stitches or clips. This prevents the extra blood from entering the lungs. Premature babies require this surgery.
If your baby is able to be discharged home before having a repair procedure, you will be shown how to feed and give medicine to your baby. You will also be taught about what symptoms to report to your child's healthcare provider.
When your child is discharged after the PDA repair, you may give pain medicine such as acetaminophen or ibuprofen to keep your child comfortable. Your child's cardiac team will discuss pain control before your child goes home.
Often infants who fed poorly before surgery have more energy once they recover. They begin to eat better and gain weight faster.
Within a few weeks after surgery, older children are usually fully recovered and able to do normal activities.
You will get other instructions from your child's cardiac team and the hospital staff.
In premature infants, the outlook after PDA surgical repair depends on gestational age and overall health.
In children born full-term, early diagnosis and repair of PDA lets them live normal, healthy lives. Activity levels, appetite, and growth should return to normal. Your child's cardiologist may recommend that your child take antibiotics to prevent infection in the heart lining and valves (bacterial endocarditis).
In children with large PDAs diagnosed very late or never repaired, the outlook is uncertain. They are at risk for increased blood pressure in the blood vessels of the lungs (pulmonary hypertension). These children should get follow-up at a care center that specializes in congenital heart disease.
Talk with your child's cardiologist about your child’s outlook.Call your child's healthcare provider if your child's symptoms get worse, or if new symptoms develop, particularly breathing or feeding problems.
- PDA is a heart defect in which a normal fetal connection between the aorta and the pulmonary artery does not close as it should after birth.
- PDA occurs most commonly in premature infants and often occurs with other congenital heart defects.
- A small PDA may close on its own as your child grows. If it is large or does not close, your child will need a repair procedure.
- An infant or child with PDA will be cared for by a pediatric cardiologist.
- Most children with a repaired PDA will live normal, health lives.
Tips to help you get the most from a visit to your child’s healthcare provider:
- Know the reason for the visit and what you want to happen.
- Before your visit, write down questions you want answered.
- At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
- Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
- Ask if your child’s condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if your child does not take the medicine or have the test or procedure.
- If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
- Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.
January 16, 2018
Management of patent ductus arteriosus, Up To Date
Ayden, Scott, MD,Bass, Paul F., III, MD, MPH