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Patent Ductus Arteriosus
PDA; Patency of the Ductus Arteriosus
Patent ductus arteriosus (PDA) is common type of simple congenital heart defect which occurs when a connection between the heart’s two major arteries does not close properly after birth. This leaves an opening through which blood can flow when it should not. Small openings may close on their own. Find out possible symptoms and treatment options.
Heart patent ductus arteriosus anatomic illustration
Image by Patrick J. Lynch, medical illustrator; C. Carl Jaffe, MD, cardiologist
What Is Patent Ductus Arteriosus?
Image by National Heart Lung and Blood Institute (NIH)
This common type of simple congenital heart defect occurs when a connection between the heart’s two major arteries does not close properly after birth. This leaves an opening through which blood can flow when it should not. Small openings may close on their own.
Source: National Heart, Lung, and Blood Institute
Hearts of strength - Shows off his scar after having multiple open heart surgeries due to hypoplastic left heart surgery.
Image by U.S. Air Force photo by Airman Michael S. Murphy
One very common form of interatrial septum pathology is patent foramen ovale, which occurs when the septum primum does not close at birth, and the fossa ovalis is unable to fuse. The word patent is from the Latin root patens for “open.” It may be benign or asymptomatic, perhaps never being diagnosed, or in extreme cases, it may require surgical repair to close the opening permanently. As much as 20–25 percent of the general population may have a patent foramen ovale, but fortunately, most have the benign, asymptomatic version. Patent foramen ovale is normally detected by auscultation of a heart murmur (an abnormal heart sound) and confirmed by imaging with an echocardiogram. Despite its prevalence in the general population, the causes of patent ovale are unknown, and there are no known risk factors. In nonlife-threatening cases, it is better to monitor the condition than to risk heart surgery to repair and seal the opening.
Coarctation of the aorta is a congenital abnormal narrowing of the aorta that is normally located at the insertion of the ligamentum arteriosum, the remnant of the fetal shunt called the ductus arteriosus. If severe, this condition drastically restricts blood flow through the primary systemic artery, which is life threatening. In some individuals, the condition may be fairly benign and not detected until later in life. Detectable symptoms in an infant include difficulty breathing, poor appetite, trouble feeding, or failure to thrive. In older individuals, symptoms include dizziness, fainting, shortness of breath, chest pain, fatigue, headache, and nosebleeds. Treatment involves surgery to resect (remove) the affected region or angioplasty to open the abnormally narrow passageway. Studies have shown that the earlier the surgery is performed, the better the chance of survival.
A patent ductus arteriosus is a congenital condition in which the ductus arteriosus fails to close. The condition may range from severe to benign. Failure of the ductus arteriosus to close results in blood flowing from the higher pressure aorta into the lower pressure pulmonary trunk. This additional fluid moving toward the lungs increases pulmonary pressure and makes respiration difficult. Symptoms include shortness of breath (dyspnea), tachycardia, enlarged heart, a widened pulse pressure, and poor weight gain in infants. Treatments include surgical closure (ligation), manual closure using platinum coils or specialized mesh inserted via the femoral artery or vein, or nonsteroidal anti-inflammatory drugs to block the synthesis of prostaglandin E2, which maintains the vessel in an open position. If untreated, the condition can result in congestive heart failure.
Septal defects are not uncommon in individuals and may be congenital or caused by various disease processes. Tetralogy of Fallot is a congenital condition that may also occur from exposure to unknown environmental factors; it occurs when there is an opening in the interventricular septum caused by blockage of the pulmonary trunk, normally at the pulmonary semilunar valve. This allows blood that is relatively low in oxygen from the right ventricle to flow into the left ventricle and mix with the blood that is relatively high in oxygen. Symptoms include a distinct heart murmur, low blood oxygen percent saturation, dyspnea or difficulty in breathing, polycythemia, broadening (clubbing) of the fingers and toes, and in children, difficulty in feeding or failure to grow and develop. It is the most common cause of cyanosis following birth. The term “tetralogy” is derived from the four components of the condition, although only three may be present in an individual patient: pulmonary infundibular stenosis (rigidity of the pulmonary valve), overriding aorta (the aorta is shifted above both ventricles), ventricular septal defect (opening), and right ventricular hypertrophy (enlargement of the right ventricle). Other heart defects may also accompany this condition, which is typically confirmed by echocardiography imaging. Tetralogy of Fallot occurs in approximately 400 out of one million live births. Normal treatment involves extensive surgical repair, including the use of stents to redirect blood flow and replacement of valves and patches to repair the septal defect, but the condition has a relatively high mortality. Survival rates are currently 75 percent during the first year of life; 60 percent by 4 years of age; 30 percent by 10 years; and 5 percent by 40 years.
In the case of severe septal defects, including both tetralogy of Fallot and patent foramen ovale, failure of the heart to develop properly can lead to a condition commonly known as a “blue baby.” Regardless of normal skin pigmentation, individuals with this condition have an insufficient supply of oxygenated blood, which leads to cyanosis, a blue or purple coloration of the skin, especially when active.
Septal defects are commonly first detected through auscultation, listening to the chest using a stethoscope. In this case, instead of hearing normal heart sounds attributed to the flow of blood and closing of heart valves, unusual heart sounds may be detected. This is often followed by medical imaging to confirm or rule out a diagnosis. In many cases, treatment may not be needed. Some common congenital heart defects are illustrated in Figure.
Figure. Congenital Heart Defects (a) A patent foramen ovale defect is an abnormal opening in the interatrial septum, or more commonly, a failure of the foramen ovale to close. (b) Coarctation of the aorta is an abnormal narrowing of the aorta. (c) A patent ductus arteriosus is the failure of the ductus arteriosus to close. (d) Tetralogy of Fallot includes an abnormal opening in the interventricular septum.
Source: CNX OpenStax
Cell Division
Image by CNX Openstax
If your child has patent ductus arteriosus (PDA), you may think you did something wrong during your pregnancy to cause the problem. However, the cause of patent ductus arteriosus isn't known.
Genetics may play a role in causing the condition. A defect in one or more genes might prevent the ductus arteriosus from closing after birth.
Source: National Heart, Lung, and Blood Institute
Occurrences of Congenital Heart disease
Image by TheVisualMD
Congenital heart defects are the most common type of birth defect, occurring in about one percent of live births in the United States. If your child has a congenital heart defect, you may think you did something wrong during your pregnancy to cause the problem.
However, doctors often do not know why congenital heart defects occur. Researchers do know that the risk of having a baby with a congenital heart defect is influenced by family history and genetics, the mother’s health, sex, and exposure during pregnancy to environmental factors, such as smoke or certain medicines. Other medical conditions can also raise your risk for having a baby with a congenital heart defect.
Source: National Heart, Lung, and Blood Institute
Heart Sounds
Image by Madhero88
A small PDA may not cause any symptoms. However, some infants may have symptoms such as:
Source: NIH MedlinePlus Magazine
Prenatal Ultrasonography
Image by TheVisualMD
Babies with PDA often have a heart murmur that can be heard with a stethoscope. However, in premature infants, a heart murmur may not be heard. The health care provider may suspect the condition if the infant has breathing or feeding problems soon after birth.
Changes may be seen on chest x-rays. The diagnosis is confirmed with an echocardiogram.
Sometimes, a small PDA may not be diagnosed until later in childhood.
Source: NIH MedlinePlus Magazine
Fetal Echocardiogram
Also called: Fetal echo, Fetal echocardiography
A fetal echocardiogram (also called a fetal echo) uses sound waves to check the heart of your unborn baby. It is used to evaluate the position, size, structure, function and rhythm of your baby's heart.
Electrocardiogram
Also called: EKG, ECG
An electrocardiogram (EKG) is a test that measures electrical signals in your heart. An abnormal EKG can be a sign of heart damage or disease.
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How Is Patent Ductus Arteriosus Treated?
Image by BruceBlaus
If there are no other heart defects present, often the goal of treatment is to close the PDA. If the baby has certain other heart problems or defects, keeping the ductus arteriosus open may be lifesaving. Medicine may be used to stop it from closing.
Sometimes, a PDA may close on its own. In premature babies, it often closes within the first 2 years of life. In full-term infants, a PDA that remains open after the first several weeks rarely closes on its own.
When treatment is needed, medicines such as indomethacin or ibuprofen are often the first choice. Medicines can work very well for some newborns, with few side effects. The earlier treatment is given, the more likely it is to succeed.
If these measures do not work or can't be used, the baby may need to have a medical procedure.
A transcatheter device closure is a procedure that uses a thin, hollow tube placed into a blood vessel. The doctor passes a small metal coil or other blocking device through the catheter to the site of the PDA. This blocks blood flow through the vessel. These coils can help the baby avoid surgery.
Surgery may be needed if the catheter procedure does not work or it cannot be used due to the baby's size or other reasons. Surgery involves making a small cut between the ribs to repair the PDA.
Source: NIH MedlinePlus Magazine
Patent Ductus Arteriosus (PDA)
Image by Blausen.com staff (2014). Medical gallery of Blausen Medical 2014
If a small PDA stays open, the baby may eventually develop heart symptoms. Babies with a larger PDA could develop heart problems such as heart failure, high blood pressure in the arteries of the lungs, or an infection of the inner lining of the heart if the PDA does not close.
Source: NIH MedlinePlus Magazine
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