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Patent Ductus Arteriosus
Introduction
Patent ductus arteriosus (PDA) is a persistent, abnormal opening between two major blood vessels leading from the heart. Fortunately, this heart defect present at birth (congenital) often closes on its own or is readily treatable.
A small patent ductus arteriosus often doesn't cause symptoms. A doctor may discover it during a routine exam. An infant with a larger patent ductus arteriosus often has trouble gaining weight and exhibits other symptoms. An older child with a patent ductus arteriosus may not be as active as normal, may tire more easily and may have frequent lung infections.
Treatment options for repairing a patent ductus arteriosus include medications and surgery.
Signs and symptoms
Signs and symptoms of a patent ductus arteriosus vary with the size of the defect and the gestational age of the infant at birth. A small patent ductus may cause no signs or symptoms, and may go undetected for some time. A larger one can cause signs of heart failure soon after birth. A premature infant may have other problems associated with prematurity, and related testing may uncover a heart defect.
Your doctor may first suspect a heart defect during a regular checkup while listening to your baby's heart through a stethoscope.
A large patent ductus arteriosus may cause:
- Poor eating, poor growth.
- Sweating with crying or play.
- Persistent fast breathing or breathlessness.
- Easy tiring.
- Rapid heart rate.
- Frequent lung infections.
Patent ductus arteriosus is common in premature babies, but rare in infants born at full term.
As a baby develops in the womb, a vascular connection (ductus arteriosus) between two major blood vessels leading from the heart — the aorta and pulmonary artery — is a normal and necessary part of fetal circulation. But, this duct is supposed to close within two or three days after birth once the newborn's heart adapts to life outside the womb. In premature infants, the duct often closes on its own within a few weeks of birth. But if the duct remains open, it's referred to as a patent ductus arteriosus.
The abnormal opening causes too much blood to circulate to the lungs and heart. If not treated, the blood pressure in the lungs may increase (pulmonary hypertension) and the heart may weaken.
Congenital heart defects arise from errors early in the heart's development — but there's often no clear cause. Genetics and perhaps environmental factors may play a role.
Treatment
In a premature infant, the patent ductus arteriosus often closes on its own in the weeks after birth. In a full-term infant, a patent ductus arteriosus usually will close within the first few days of life. If the defect doesn't close and is causing health problems, medications or surgery may be used to close it.
Medications
Doctors use nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or indomethacin, to help close a patent ductus arteriosus in premature infants. NSAIDs block the hormone-like chemicals in the body that keep the PDA open.
Surgery
Surgery to repair a patent ductus arteriosus involves patching or sewing shut the abnormal opening. This can be done through an incision in the side of the chest or by catheterization. In cardiac catheterization, 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 may be deployed to close the ductus arteriosus. In surgery, the ductus is closed with a metal clip.
Preventive antibiotics
In the past, it was recommended that people with an unrepaired patent ductus arteriosus take antibiotics before dental work and certain types of surgical procedures to prevent infective endocarditis.
But new guidelines issued by the American Heart Association in 2007 have substantially revised this recommendation. After weighing the risks and benefits of preventive antibiotics, the reviewing committee found that the risks outweighed the benefits for most people, except a small group at high risk of serious complications of infectious endocarditis.
The reviewers found that random germs caused infectious endocarditis more frequently than did routine dental or medical procedures. They suggest a more effective strategy for preventing endocarditis may be to practice good oral hygiene and get regular dental checkups. They also noted that taking preventive antibiotics carries certain uncommon though possible risks, such as an allergic reaction, and may contribute to growing antibiotic resistance.
Because of these changes, preventive antibiotics are no longer recommended for many people with a patent ductus arteriosus. However, some people still need antibiotics, such as those who:
- Have other heart conditions or artificial valves.
- Have a large defect that's causing a low blood oxygen level.
- Have had repair with prosthetic material.
Prevention
In most cases, you can't do anything to prevent having a baby with a heart defect. However, it's important to do everything possible to have a healthy pregnancy. Here are the basics:
- Get early prenatal care, even before you're pregnant. Quitting smoking, reducing stress, stopping birth control — these are all things to talk to your doctor about before you get pregnant. Also, be sure you talk to your doctor about any medications you're taking.
- Eat a well-balanced diet. Include a vitamin supplement that contains folic acid. Also, limit caffeine.
- Exercise regularly. Work with your doctor to develop an exercise plan that's right for you.
- Avoid risks. These include harmful substances such as alcohol, cigarettes and illicit drugs. Also, avoid X-rays, hot tubs and saunas.
- Avoid infections. Be sure you are up to date on all of your vaccinations before becoming pregnant. Certain types of infections can be harmful to a developing fetus.
- Keep diabetes under control. If you have diabetes, work with your doctor to be sure its well controlled before and after getting pregnant.
Information obtained from National Institute of Health