Patent ductus arteriosus

Overview

The patent ductus is a temporary blood vessel that is part of the fetal blood circulation system. In the womb, the patent ductus is open, allowing blood to bypass the lungs since babies rely on oxygenated blood from their mothers and don't breathe through their own lungs until after birth. Normally, the patent ductus closes within the first 15 hours after birth and almost all close during the first year. If the ductus stays open after birth, blood leaks back into the lungs, causing a condition called patent ductus arteriosus (PDA). PDA can place strain on the heart and lead to congestive heart failure.

This condition also can cause symptoms such as high blood pressure in the pulmonary arteries, leading to thickening of the arteries and a condition called pulmonary vascular disease. Children with PDA also are at an increased risk for heart infections called endocarditis. PDA can affect children with otherwise healthy hearts or it may occur with other heart defects. In some conditions, the open ductus may compensate for blockage elsewhere in the heart's circulation system.

Signs & symptoms

Most children with patent ductus arteriosus don't have obvious symptoms unless congestive heart failure develops. PDA symptoms associated with congestive heart failure include rapid breathing, feeding difficulties and cold sweat.

Diagnosis

To diagnose patent ductus arteriosis (PDA), your doctor will conduct a thorough medical exam. Most children with PDA have a distinctive heart murmur, which can be easily detected by a doctor. Tests may be performed to make a definite diagnosis and rule out other conditions that cause heart murmurs. These may include:

• Chest X-ray to see the heart's size
• Echocardiogram, a test that uses sound waves to create a moving picture of the heart
• Electrocardiogram (ECG or EKG), a test that records the electrical activity of the heart

Treatment

Small patent ductus arteriosus (PDA) often close over time and only require anti-infection medications. If the PDA is large, congestive heart failure may develop and other medications may be needed. In newborns, a drug called Indomethacin may be given to help close the PDA.

If a PDA remains open when your child is 1 to 2 years of age or if congestive heart failure doesn't respond to medication, the opening must be closed by surgery or a less invasive procedure called cardiac catheterization.

Cardiac catheterization uses long, flexible, narrow tubes, called catheters, which are inserted through a tiny incision into the large blood vessels in the legs. The tubes are directed through the blood vessels to the heart. Once in the heart, the catheters are used as conduits to place small metal coils or plugs in the ductus vessel. The coil or plug blocks blood flow through the ductus and is covered completely by the lining of the blood vessel.

This procedure takes about three hours and is performed in our Pediatric Cardiac Catheterization Laboratory. In most cases, patients are discharged from the hospital the same day as the procedure.

Surgery may be necessary if the PDA is large or the baby is very young. A small incision is made on the left side of the chest between the ribs. The ductus is either tied off or divided. The surgery usually requires a hospital stay of several days for recovery.