Patent Ductus Arteriosus
Pronounced: PA-tent DUC-tus Ar-Ter-e-O-sus
A patent ductus arteriosus (PDA) is a type of congenital (present at birth) heart problem. All babies have a small passageway (called the ductus arteriosus) connecting the pulmonary artery and the aorta, which is open at birth.
The pulmonary artery is a blood vessel that moves blood from the heart to the lungs. The aorta is a blood vessel that moves blood from the heart out to the rest of the body. Before birth, the baby gets its oxygen from the mother, so its lungs are not used. The ductus arteriosus is a passageway between the pulmonary artery and the aorta that allows blood in the baby to bypass the unused lungs and carry oxygen to the other organs.
In most babies, the ductus arteriosus closes within a few hours of birth. This is normal. When the ductus arteriosus stays open, blood travels in the wrong direction between the aorta and pulmonary artery. This can cause problems for a baby, often calling for medical or surgical attention.
Patent Ductus Arteriosus
In most cases, the cause is not known. However, in a small number of cases, PDA could be caused by exposure during pregnancy to a viral infection, rubella]]> , ]]>drugs]]> , or ]]>alcohol]]> . In some children, congenital heart disease, including patent ductus arteriosus, may be caused by genetic factors.
A risk factor is something that increases your chance of getting a disease or condition. Premature babies are at relatively high risk for PDA, although a patent ductus often closes when the baby becomes more mature. In most cases occurring in full term babies, there are no known risk factors for PDA.
Symptoms vary with the size of the ductus and the amount of blood that flows through it. If the ductus is small, there may be no symptoms. When symptoms occur, they include:
- Rapid breathing
- Increased work to breathe
- Getting tired quickly
- Poor growth
- Respiratory infections (eg, colds]]> , ]]>pneumonia]]> ) occurring more often
In some babies, symptoms may not occur until a few weeks or months after birth. Even when there are no symptoms, the baby is at higher risk for a serious infection called ]]>endocarditis]]> .
A PDA causes a heart murmur]]> because of the blood flow from the aorta to the pulmonary artery. This characteristic sound can be heard during a physical exam. In premature babies, this heart murmur—accompanied by ]]>heart failure]]> —is enough to diagnose PDA. A ]]>chest x-ray]]> shows an enlarged heart and extra blood flow from the heart to the lungs.
In older children, a chest x-ray is usually normal. An ]]>echocardiogram]]> is done to confirm the diagnosis. It uses high-frequency sound waves called ultrasound to show the flow of blood through the PDA.
In symptomatic newborns, if the heart failure can be managed easily, extra time may be allowed to see if the PDA will close on its own. Fluids may be restricted somewhat for 2-3 days to help it close. If the symptoms are serious or the PDA is not likely to close on its own, medicine or surgery is used to close it. The medicine, indomethacin, helps tighten the muscle in the wall of the PDA to close it. If this does not work, surgery is performed to tie off the PDA.
If a PDA is present after the newborn period, it usually will not close on its own or with indomethacin. Surgery is required to prevent complications.
In older children, small coils can be used in place of surgery to close a PDA. The coils are placed in the PDA during cardiac catheterization]]> , a procedure in which a small hollow tube is inserted into the heart through a large vein. The coils pass through the tube, placed directly into the ductus arteriosus, then expanded to block the flow of blood.
Surgery and coil placement are both quite safe, although the risk of complication rises if associated heart failure is very severe.
American Heart Association
Children's Heart Institute
Canadian Cardiovascular Society
Canadian Family Physician
American Heart Association website. Available at: http://www.americanheart.org .
Patent ductus arteriosus. In: The Heart Center Encyclopedia . Cinnicinati Children's Hospital Heart Center at the Cinncinati Children's Hospital Medical Center website. Available at: http://www.cincinnatichildrens.org/ . Accessed December 2002.
Understanding congenital heart defects. Mayo Adult Congenital Heart Disease Clinic, Mayo Foundation for Medical Education and Research website. Available at: http://www.mayoclinic.com . Accessed October 2002.
Last reviewed November 2008 by ]]>Michael J. Fucci, DO]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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