Patent Ductus Arteriosus

What Is Patent Ductus Arteriosus?

The ductus arteriosus is a normal blood vessel in a fetus that diverts blood flow away from the lungs. The DA usually closes on its own shortly after birth because the newborn can breathe on his or her own. If the DA doesn’t close, this is called patent ductus arteriosus (PDA),which can result in too much blood flow to a newborn’s lungs. PDA is common in premature babies.

What Are the Signs and Symptoms of Patent Ductus Arteriosus?

• Tachycardia
• Respiratory problems
• Dyspnea – shortness of breath
• Continuous machine-like heart murmur
• Cardiomegaly – enlarged heart
• Left subclavicular thrill
• Bounding pulse
• Widened pulse pressure
• Poor growth
• Differential cyanosis

How Is Patent Ductus Arteriosus Diagnosed?

PDA is usually diagnosed using non-invasive techniques. Echocardiography, in which sound waves are used to capture the motion of the heart, and associated Doppler studies are the primary methods of detecting PDA. A chest X-ray may be taken, which reveals the overall size of neonate’s heart and the appearance of the blood flow to the lungs. A small PDA most often shows a normal sized heart and normal blood flow to the lungs. A large PDA generally shows an enlarged cardiac silhouette and increased blood flow to the lungs.

How Is Patent Ductus Arteriosus Treated?

• PDAs can be closed by percutaneous interventional method via the femoral vein or femoral artery,a platinum coil can be deployed via a catheter,which induces thrombosis. Alternatively, a PDA occluder device composed of nitinol mesh, is deployed from the pulmonary artery through the PDA.The larger skirt of the device sits on the aortic side while the ampulla of the device hugs the walls of the PDA, with care taken to avoid occlusion of the pulmonary arterial lumen by the device.These methods permit closure without open heart surgery.
• Open-heart surgery: If medications haven’t closed the PDA, and your baby’s condition has caused health problems, a surgeon will make a small cut between your child’s ribs to reach your child’s heart and repair the open duct using stitches or clips.
• Neonates without adverse symptoms may simply be monitored as outpatients,while symptomatic PDA can be treated with both surgical and non-surgical methods.
• Surgically, the DA may be closed by ligation wherein the DA is manually tied shut,or with intravascular coils or plugs that leads to formation of a thrombus in the DA.
• Catheter procedures: A thin tube (catheter) is inserted into a blood vessel in the groin and threaded up to the heart through the catheter, a plug or coil is inserted to close the ductus arteriosus.