Patent ductus arteriosus (PDA) is a Congenital defect in which the temporary blood vessel connecting the left pulmonary artery to the aorta in the fetal heart fails to close after birth. In the fetal heart, blood bypasses the lungs and gets oxygen from the placenta. But when the newborn's lungs take over at birth, the body stops producing the chemicals that keep the ductus arteriosus open, and it closes naturally.
If the ductus arteriosus fails to close completely, the baby has PDA. While this problem is rare, it is sometimes associated with mothers who have had German measles (rubella) during pregnancy and with infants born before their due date (prematurely).
The result of this defect is that too much blood travels to the lungs. The severity of the problem depends on how large the opening is and how prematurely the baby was born.
Figure A shows the normal anatomy and blood flow of the interior of the heart. Figure B shows a heart with a patent ductus arteriosus. The defect connects the aorta with the pulmonary artery, allowing oxygen-rich blood from the aorta to mix with oxygen-poor blood in the pulmonary artery.
A PDA is a type of congenital heart defect. A congenital heart defect is any type of heart problem that is present at birth.
If your baby has a PDA, but has an otherwise normal heart, the PDA may shrink and go away completely, or it may need to be treated to close it. But, if your baby is born with certain types of heart defects that decrease blood flow from the heart to the lungs or the body, medicine may be given to keep the ductus arteriosus open to maintain blood flow and oxygen levels until corrective surgery for the heart defect(s) can be performed.
About 3,000 infants are diagnosed with PDA each year in the United States. It is more common in premature infants (babies born too early) but does occur in full-term infants. Premature babies with PDA are more vulnerable to its effects. PDA is twice as common in girls as in boys.
What Causes Patent Ductus Arteriosus ?
The cause of patent ductus arteriosus (PDA) is not known.
Genetics may play a role. A defect in one or more genes could prevent the ductus arteriosus from closing normally after birth.
PDA is more common in : -
Premature infants (babies born too early)
Infants with genetic abnormalities such as Down syndrome
Infants whose mother had German measles (rubella) during pregnancy
What Are the Signs and Symptoms of Patent Ductus Arteriosus ?
A heart murmur may be the only sign that a baby has patent ductus arteriosus (PDA). A heart murmur is an extra or unusual sound heard during the heartbeat.
Some infants may develop signs or symptoms of volume overload on the heart and excess blood flow in the lungs.
Signs and symptoms may include : -
Fast breathing, working hard to breathe, or shortness of breath, or in the case of a premature infant, need for increased oxygen or ventilatory support
Poor feeding and poor weight gain
Tiring easily
Sweating with exertion (such as while feeding)
How Is Patent Ductus Arteriosus Diagnosed ?
In full-term infants, a patent ductus arteriosus (PDA) usually is first suspected when the baby's doctor hears a heart murmur during a regular checkup. If a PDA is large, the infant may also develop symptoms of volume overload and increased blood flow to the lungs. When a PDA is small, it may not be diagnosed until later in childhood. Once a PDA is suspected, a consultation with a pediatric cardiologist will be arranged. A pediatric cardiologist is a doctor who specializes in diagnosing and treating heart problems in children.
In premature babies (babies born too early) with PDA, the physical signs that are seen in full-term babies, such as heart murmur, may not be present. Doctors may suspect a PDA in premature babies who develop breathing difficulties soon after birth. Doctors use tests such as echocardiography to look for PDA in premature babies with breathing problems.
Tests for Patent Ductus Arteriosus
Two painless tests are used to diagnose a PDA.
Echocardiogram :- This test, which is harmless and painless, uses sound waves to create a moving picture of your baby's heart. During an echocardiogram, reflected sound waves outline the heart's structure completely. The test allows the doctor to clearly see any problem with the way the heart is formed or the way it's working. An echocardiogram is the most important test available to your baby's cardiologist to both diagnose a heart problem and follow the problem over time. In babies with PDA, the echocardiogram shows how big the ductus is and how well the heart is responding to it. When medical treatments are used to try to close a ductus in premature babies, echocardiograms are used to see how well the treatment is working.
EKG (electrocardiogram) : - This test records the electrical activity in the heart. In the case of a PDA, it can show:
Enlargement of the heart chambers
Other subtle changes that can suggest the presence of a PDA
Treatment for patent ductus arteriosus
Specific treatment for PDA will be determined by your child's physician based on : -
your child's age, overall health, and medical history
extent of the disease
your child's tolerance for specific medications, procedures, or therapies
expectations for the course of the disease
your opinion or preference
A small patent ductus arteriosus may close spontaneously as your child grows. A PDA that causes symptoms will require medical management, and possibly even surgical repair. Your child's cardiologist will check periodically to see whether the PDA is closing on its own. If a PDA does not close on its own, it will be repaired to prevent lung problems that will develop from long-time exposure to extra blood flow.
Treatment may include : -
medical management
In premature infants, an intravenous (IV) medication called indomethacin may help close a patent ductus arteriosus. Indomethacin is related to aspirin and ibuprofen and works by stimulating the muscles inside the PDA to constrict, thereby closing the connection. Your child's physician can answer any further questions you may have about this treatment.
As previously mentioned, some children will have no symptoms, and require no medications. However, others may need to take medications to help the heart and lungs work better. Medications that may be prescribed include the following:
digoxin : - a medicine that helps strengthen the heart muscle, enabling it to pump more efficiently.
diuretics : - the body's water balance can be affected when the heart is not working as well as it could. These medications help the kidneys remove excess fluid from the body.
adequate nutrition
Most infants with PDA eat and grow normally, but premature infants or those infants with a large PDA may become tired when feeding, and are not able to eat enough to gain weight. Options that can be used to ensure your baby will have adequate nutrition include the following:
high-calorie formula or breast milk : - Special nutritional supplements may be added to formula or pumped breast milk that increase the number of calories in each ounce, thereby allowing your baby to drink less and still consume enough calories to grow properly.
supplemental tube feedings : - Feedings given through a small, flexible tube that passes through the nose, down the esophagus, and into the stomach, can either supplement or take the place of bottle-feedings. Infants who can drink part of their bottle, but not all, may be fed the remainder through the feeding tube. Infants who are too tired to bottle-feed may receive their formula or breast milk through the feeding tube alone.
PDA repair or closure in India
The majority of infants and children with PDA are candidates for repair in the cardiac cath lab. The goal is to repair the PDA before the lungs become diseased from too much blood flow and pressure.
Repair is usually indicated in infants younger than 6 months of age who have large defects that are causing symptoms, such as poor weight gain and rapid breathing. For infants who do not exhibit symptoms, the repair may often be delayed until after 6 months of age. Your child's cardiologist will recommend when the repair should be performed.
Transcatheter coil closure of the PDA is frequently used because it is minimally invasive. However, premature infants are not candidates for this procedure.
Your child's PDA may be repaired surgically in the operating room. The surgical repair, also called PDA ligation, is performed under general anesthesia. The procedure involves closing the open PDA with stitches to prevent the surplus blood from entering your child's lungs. Alternately, the vessel connecting the aorta and pulmonary artery may be cut and cauterized (sealed off by burning with an electrical instrument).
Post-procedure care for your child : -
Cath lab PDA repair/closure procedure
When the procedure is complete, the catheter(s) will be withdrawn. Several gauze pads and a large piece of medical tape will be placed on the site where the catheter was inserted to prevent bleeding. In some cases, a small, flat weight or sandbag may be used to help keep pressure on the catheterization site and decrease the chance of bleeding. If blood vessels in the leg were used, your child will be told to keep the leg straight for a few hours after the procedure to minimize the chance of bleeding at the catheterization site.
Your child will be taken to a unit in the hospital where he/she will be monitored by nursing staff for several hours after the test. The length of time it takes for your child to wake up after the procedure will depend on the type of medicine given to your child for relaxation prior to the test, and also on your child's reaction to the medication.
After the procedure, your child's nurse will monitor the pulses and skin temperature in the leg or arm that was used for the procedure.
Your child may be able to go home after a specified period of time, providing he/she does not need further treatment or monitoring. You will receive written instructions regarding care of the catheterization site, bathing, activity restrictions, and any new medications your child may need to take at home.
Surgical repair (PDA Surgery)
Some children who undergo PDA ligation may need to spend some time in the intensive care unit after surgery. Others may return to a regular hospital room. Your child will be kept as comfortable as possible with medications which relieve pain or anxiety. The staff will also be asking for your input as to how best to soothe and comfort your child.
You will also learn how to care for your child at home before your child is discharged. The staff will give you instructions regarding medications, activity limitations, and follow-up appointments before your child is discharged. Most children will only need to stay in the hospital for a few days after the operation.
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