Patent ductus arteriosus (PDA) is a heart condition that occurs when the ductus arteriosus does not close. The ductus arteriosus is a temporary blood vessel that connects the pulmonary artery (the main heart vessel to the lungs) to the aorta (the main blood vessel of the body). Everyone is born with a ductus arteriosus, but it closes after birth. If it remains open after birth, it is called a patent ductus arteriosus or PDA. You can find more information below.
What is a patent ductus arteriosus (PDA)?
A patent ductus arteriosus (PDA) is a permanent opening between the two main blood vessels leaving the heart. The opening, called the ductus arteriosus, is a normal part of the baby’s circulatory system before birth and usually closes shortly after birth. However, if it remains open, it is called a patent ductus arteriosus.
A small patent ductus arteriosus often causes no problems and may never need treatment. However, a large patent ductus arteriosus left untreated can allow poorly oxygenated blood to flow in the wrong direction, weakening the heart muscle, causing heart failure and other complications.
Treatment options for patent ductus arteriosus include closure with regular monitoring, medications, cardiac catheterization, or surgery.
Causes of patent ductus arteriosus (PDA)
Congenital heart defects are caused by problems early in the heart’s development – but often have no clear cause. Genetic factors may play a role.
Before birth, a vascular connection (ductus arteriosus) is required between the two major blood vessels (aorta and pulmonary artery) leaving the heart for the baby’s blood circulation. The ductus arteriosus diverts blood from the baby’s lungs as it develops, and the baby receives oxygen from the mother’s circulation.
After birth, the ductus arteriosus normally closes within two or three days. In premature babies, it usually takes longer for the connection to close. If the connection remains open, this is called a patent ductus arteriosus.
The abnormal opening causes too much blood to circulate in the baby’s lungs and heart. If left untreated, the blood pressure in the baby’s lungs may increase ( pulmonary hypertension ), and the baby’s heart may enlarge and weaken.
Who is at risk?
Risk factors for patent ductus arteriosus include:
- Premature birth: Patent ductus arteriosus (PDA) is more common in very premature babies than in full-term babies.
- Family health history and other genetic conditions: A family history of heart defects and other genetic conditions such as Down syndrome increase the risk of having PDA.
- Rubella infection during pregnancy: If you get rubella during pregnancy, your baby has an increased risk of heart defects. The rubella virus crosses the placenta, spreads through the baby’s circulatory system and damages blood vessels and organs, including the heart.
- Born at higher altitudes: Babies born above 10,000 feet (3,048 meters) have a greater risk of PDA than babies born at lower altitudes.
- Being a woman: PDA is twice as common in girls.
Patent ductus arteriosus symptoms
Patent ductus arteriosus symptoms vary depending on the size of the defect and whether the baby was born full-term or premature. A small PDA causes no symptoms and goes unnoticed for some time, even into adulthood. A large PDA can cause symptoms of heart failure soon after birth.
Your baby’s doctor may suspect a heart defect during a regular checkup after hearing a heart murmur while listening to your baby’s heart with a stethoscope.
A large PDA found in infancy or childhood can cause:
- Poor eating leads to poor growth
- Sweating while crying or eating
- rapid breathing or shortness of breath
- easy fatigue
- fast heart rate
When should you see a doctor?
You should consult a doctor if your baby or child has:
- Gets tired easily while eating or playing
- If she is not gaining weight
- Is gasping for breath while eating or crying
- Always breathing fast or experiencing shortness of breath
Diagnosis of patent ductus arteriosus (PDA)
First, the doctor may suspect a PDA condition by listening to the person’s heartbeat. PDA can cause a heart murmur that the doctor can hear with a stethoscope.
If the doctor suspects a heart defect, they may order one or more of the following tests:
- Echocardiogram: Sound waves produce images of the heart that can help the doctor identify a PDA, see if the heart chambers are enlarged, and decide how well the heart is pumping. This test also helps the doctor evaluate heart valves and detect other potential heart defects.
- Chest X-ray: An X-ray image helps the doctor see the condition of the person’s heart and lungs. An X-ray can also reveal conditions other than a heart defect.
- Electrocardiogram: This test records the electrical activity of the heart, which can help a doctor diagnose heart defects or rhythm problems.
- Cardiac catheterization: This test is usually not only needed to diagnose PDA, but may be done during an echocardiogram or to examine congenital heart defects if a catheter procedure is being considered for the treatment of PDA. A thin, flexible tube (catheter) is inserted into a blood vessel in the groin or arm and guided through it to the heart. Through catheterization, the doctor can perform procedures to close the patent ductus arteriosus.
Patent ductus arteriosus (PDA) treatment
The treatment of patent ductus arteriosus depends on the age of the person being treated. Options may include:
- Watchful waiting: A PDA in a premature baby often closes on its own. The doctor will monitor your baby’s heart to make sure the open blood vessel is closing properly. For normal-born infants, children, and adults with small PDAs that do not cause other health problems, regular monitoring may be all that is needed.
- Medications: In a premature baby, non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or indomethacin may be used to help close the PDA . NSAIDs block hormone-like chemicals in the body that keep PDA open. NSAIDs do not close the PDA in term infants, children or adults. Remember, your doctor will decide which medicine to take and how.
- Surgical closure: If medications are not effective and the child’s condition is severe or causing complications, surgery may be recommended. A surgeon makes a small cut between your child’s ribs to reach the child’s heart and repair the open canal using stitches or clips. After surgery, your child will stay in the hospital for a few days for observation. It usually takes a few weeks for a child to fully recover from heart surgery. Sometimes, surgical closure may also be recommended for adults who have a PDA that is causing health problems. Possible risks of surgery include hoarseness, bleeding, infection, and a paralyzed diaphragm.
- Catheter procedures: Premature babies are too small for catheter procedures. However, if the baby does not have health problems with the PDA, the doctor may recommend waiting until the baby is older to correct the PDA and have the catheter procedure. Catheter procedures can also be used to treat full-term infants, children, and adults. In a catheter procedure, a thin tube (catheter) is inserted into a blood vessel in the groin and threaded toward the heart. A plug or coil is placed through the catheter to close the ductus arteriosus.
In the past, people who had PDA were advised to take antibiotics before other studies and certain surgical procedures to prevent heart infection ( infective endocarditis ). Today, preventive antibiotics are no longer recommended for most people with ductus arteriosus.
In the first six months after a catheter repair procedure, the person concerned may need to take preventive antibiotics if there is still damage after the repair or if there has been a previous infection of the heart. Before any procedure, your doctor will give you the necessary information about whether you or your child needs to take antibiotics.
Necessary follow-up care
If you have PDA, you may be at risk of developing complications as an adult, even if you had surgery as a child. That’s why it’s important to have lifelong follow-up care, especially if you’ve had corrective heart surgery.
This follow-up care can be as simple as having periodic check-ups with your doctor or include regular screenings for complications. The important thing is to discuss your care plan with your doctor and make sure you follow all doctor’s recommendations.
Ideally, a cardiologist will manage your care to treat adults with congenital heart defects.
Can patent ductus arteriosus be prevented?
There is no sure way to prevent having a baby with a patent ductus arteriosus. However, it is important to do everything possible for a healthy pregnancy. Here is some basic information:
- Take care of your health while pregnant: Things like quitting smoking and alcohol and reducing stress are things you should discuss with your doctor before getting pregnant. You should also inform your doctor about the medications you are taking.
- Eating healthy: In consultation with your doctor, you can add a vitamin supplement containing folic acid.
- Regular exercise: You can seek help from your doctor to develop an exercise plan that works for you.
- Avoiding risks: These include harmful substances such as alcohol, cigarettes and illegal drugs. You should also avoid hot tubs and saunas.
- Avoiding infections: Update your vaccinations before you get pregnant. Some types of infections can be harmful to a developing baby.
- Keeping diabetes under control: If you have diabetes, schedule regular doctor checkups to manage the condition before and during pregnancy.
If you have a family history of heart defects or other genetic disorders , you may want to consider talking to a genetic counselor before getting pregnant.
Complications of patent ductus arteriosus
A small PDA may not cause complications. Larger defects can cause:
- High blood pressure in the lungs (pulmonary hypertension): Too much blood circulating in the main arteries of the heart through the PDA can lead to pulmonary hypertension, which can cause permanent lung damage. A large patent ductus arteriosus can lead to Eisenmenger syndrome , an irreversible type of pulmonary hypertension .
- Heart failure: PDA can eventually cause the heart to enlarge and weaken, leading to heart failure, a chronic condition in which the heart cannot pump blood effectively.
- Heart infection (endocarditis): People with structural heart problems such as PDA have a higher risk of inflammation of the inner lining of the heart than people with healthy hearts.
Patent ductus arteriosus and pregnancy
Most women with a small patent ductus arteriosus can tolerate pregnancy without any problems. However, a larger defect or complications – such as heart failure, arrhythmias or pulmonary hypertension – can increase the risk of complications during pregnancy. If you have Eisenmenger syndrome, pregnancy should be avoided as it can be life threatening.