Patent Ductus Arteriosus
Patent ductus arteriosus (PDA) is a medical condition in which the ductus arteriosus fails to close in a baby after birth. If left untreated, it can allow oxygenated blood to flow in the wrong direction, causing heart failure and other complications.
About Patent Ductus Arteriosus
The ductus arteriosus is a blood vessel between the pulmonary artery and the aorta that is critical to your baby’s health before birth and can be lifesaving after birth for babies who experience hypoplastic left heart syndrome or other conditions. In utero, the ductus arteriosus lets blood bypass the lungs because the baby is getting oxygen from their mother and isn’t breathing on their own. After birth, the baby begins breathing on their own and the ductus arteriosus begins to close within a few days after birth.
Patent ductus arteriosus (PDA) is diagnosed when the vessel does not close after birth. Patent ductus arteriosus impacts how efficiently the heart and lungs work to pump and oxygenate the blood. An open ductus arteriosus allows blood that has already been oxygenated to circulate back through the lungs and left ventricle, forcing the lungs to handle a higher volume of blood than normal, which raises the pressure in the blood vessels. Fluid can accumulate in the lungs as a result, making it difficult for your baby to eat and breathe. Patent ductus arteriosus can weaken the heart muscle and cause complications, such as infective endocarditis. Severe patent ductus arteriosus can lead to congestive heart failure.
Although the exact cause is unknown, females and premature babies are more likely to experience PDA. A baby’s risk of PDA may also increase if there is a family history of heart defects or genetic conditions or the mother experienced rubella during pregnancy. Babies born at altitudes of 10,000 feet or higher may also be at a greater risk of developing PDA than babies born at lower altitudes.
Symptoms of Patent Ductus Arteriosus
A small PDA may not cause any symptoms and could go undetected.
Symptoms of a large PDA may include:
- Frequent respiratory infections
- Heart murmur
- Heavy, rapid, or congested breathing
- Poor weight gain
- Rapid heart rate
- Trouble feeding, disinterest in eating, or tiring while feeding
Diagnosing Patent Ductus Arteriosus
During physical examinations, your child’s doctor listens to your child’s heart and lungs and may detect a heart murmur, which are extra sounds heard throughout the cardiac cycle due to increased blood flow. If your pediatrician suspects increased blood flow, a recommendation to see a pediatric cardiologist may be made.
Tests performed when diagnosing PDA may include:
- Cardiac Catheterization: During cardiac catheterization, a small catheter (thin tube) is inserted into a larger blood vessel, typically in the groin, and guided to the heart where blood pressure and oxygen measurements can be taken in the aorta and pulmonary artery as well as the four chambers of the heart. A dye can also be injected through the tube to make the heart’s structure more visible on an X-ray.
- Chest X-Ray: A chest X-ray produces an image of the tissue and bones in the heart and lungs and helps your provider assess the shape, size, and structure of the heart and lungs as well as the aeration of or any congestion in the lungs. PDA can cause an enlarged heart and changes to the lungs that may be seen on an X-ray.
- Echocardiogram: An echocardiogram uses ultrasound technology to create a moving image of the heart and its valves, allowing your provider to assess the structure and function of the heart. An echocardiogram also helps provide information about blood flow and how well the heart is pumping blood. This is helpful when determining how blood is flowing through the PDA, how much blood is passing through the vessel, and how large the ductus arteriosus is.
- Electrocardiogram (ECG or EKG): An electrocardiogram uses electrodes that are placed on the body to record the electrical activity taking place in the heart. An ECG/EKG test helps detect abnormal rhythms, such as cardiac arrhythmias, stress on the heart, and damage to the heart muscles.
Treating Patent Ductus Arteriosus
If the ductus arteriosus is small, the lungs may be able to accommodate the extra blood and treatment may not be needed. In premature babies, a PDA may close on its own after a longer period of time than expected for a baby born full-term. If your baby has a small PDA or is premature, your pediatric cardiologist may recommend monitoring your baby’s health closely.
Treatment options for a larger PDA may include:
- Cardiac Catheterization: Using the same method as for diagnosis, a small tube can be inserted through a blood vessel in the groin and guided to the heart where a coil can be placed or a plug can be inserted in the PDA.
- Medication: Intravenous, or IV, medication can be prescribed for premature babies to help a PDA close. Related to aspirin and ibuprofen, indomethacin triggers the muscles in the ductus arteriosus to constrict and close the PDA. Nonsteroidal anti-inflammatory drugs, such as ibuprofen, may also block chemicals in your baby’s body that can keep a patent ductus arteriosus open.
- Surgery: A pediatric heart surgeon may perform a surgical repair to close the patent ductus arteriosus.
After treatment, a premature baby’s prognosis can vary depending on your child’s gestational age and other conditions. Most full-term babies who had early treatment for a PDA experience healthy growth, appetite, and activity levels. Children who received PDA treatment later in life or have an unresolved PDA may need ongoing care and monitoring.
Care Team Approach
The Texas Center for Pediatric and Congenital Heart Disease, a clinical partnership between Dell Children’s Medical Center and UT Health Austin, takes a multidisciplinary approach to your child’s care. This means your child and your family will benefit from the expertise of multiple specialists across a variety of disciplines. Your care team will include pediatric cardiologists, cardiothoracic surgeons, interventional cardiologists, critical care specialists, hospitalists, anesthesiologists, perfusionists, nurses, advanced practice providers, social workers, psychologists, child life specialists, dietitians, physical and occupational therapists, pharmacists, and more, who work together to provide unparalleled care for patients every step of the way. We collaborate with our colleagues at the Dell Medical School and The University of Texas at Austin to utilize the latest research, diagnostic, and treatment techniques, allowing us to identify new therapies to improve treatment outcomes. We are committed to communicating and coordinating your child’s care with referring physicians and other partners in the community to ensure that we are providing comprehensive, whole-person care.