Patent Ductus Arteriosus (PDA)
What is Patent Ductus Arteriosus (PDA)?
A baby’s blood flows differently in the womb than after birth. While in the mother’s womb, a baby does not need his or her lungs to provide oxygen. Oxygen is provided by the mother through the placenta. A wide muscular blood vessel called the ductus arteriosus joins the fetal aorta (the body’s main artery) to the pulmonary artery (the main artery to the lungs), and this connection diverts blood from the lungs into the aorta during fetal development. After birth, normal breathing begins as the lungs take in air. The ductus arteriosus no longer is necessary, and it normally closes within minutes or days after the baby is born.
Patent ductus arteriosus (PDA) is a birth defect that occurs when the blood vessel known as the ductus arteriosus does not close properly, and instead, remains open (“patent” being a medical term for “open”). When this happens, oxygen-rich blood continues to flow from the aorta to mix with oxygen-poor blood from the pulmonary artery. This excess of blood makes the heart and lungs work harder, potentially leading to fluid in the lungs and an enlarged left heart.
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What are the causes?
PDA occurs in approximately five out of every 1,000 births, and PDA has a higher prevalence rate in premature babies. It is the fourth most common birth defect in Texas, reports the Texas Birth Defects Registry, and it is twice as common in girls, according to the National Heart, Lung, and Blood Institute (NHLBI).
Beyond premature birth, the cause of PDA is unknown, though genes may be involved, as reported by the National Heart, Lung, and Blood Institute (NHLBI). The condition occurs more often in children with Down syndrome or whose mother had German measles (rubella) during pregnancy.
How is it diagnosed?
Babies with a small PDA often have no initial symptoms, and the condition may not be diagnosed until later in childhood. A large PDA has signs similar to those of other congenital heart defects. The infant may become easily fatigued, show delayed growth, feed poorly, breathe rapidly and have a fast pulse. She or he also may have an abnormal heartbeat or heart whooshing sound, known as a murmur.
Doctors may detect PDA with a stethoscope exam. Other tests also may be ordered to reveal further details:
- Chest X-rays create images of the heart and lungs, and in a child with PDA, excess blood flow or a resulting enlargement of the left side of the heart may be visible.
- An echocardiogram (ECHO) uses sound waves (ultrasound) to produce images of the heart and vessels on a screen and can be used to confirm the condition.
How is it treated?
Medicine may be used in small or premature babies to constrict the ductus arteriosus. If medicine does not work or cannot be used, the vessel must be closed with a cardiac catheter procedure or surgery. Untreated PDA can lead to lung infections or even congestive heart failure.
In some cases, closure is minimally invasive via cardiac catheterization in a procedure referred to as transcatheter device closure. Specially-trained cardiologists insert a device into one of the large blood vessels in the groin. A closure device is delivered in collapsed form via the veins to the site of the hole in the heart. It then can be expanded and placed into position to close the PDA. Children often go home the same day as the procedure. After a few days of rest, the child can resume normal activity.
A larger PDA in a very small, premature infant may be closed with surgery via an incision between the child’s ribs (thoracotomy) to reach the open ductus arteriosus. The ductus is surgically closed with a clip or may be tied shut with a surgical band. With surgery, the child remains in the hospital for a few days before returning home.
Complications may include hoarseness, bleeding, infection, fluid buildup around the lungs or a paralyzed diaphragm, the muscle below the lungs that helps them expand.
What are the long-term effects?
Once the ductus arteriosus is closed, most children have no lasting effects. Even after chest surgery, they will recover fully and resume normal activity within weeks.
What follow-up care is needed?
Long-term follow-up care is not needed, unless the child has other health issues. For six months after a closure device is implanted, the child could develop infective endocarditis, an inflammation of the heart’s lining or valves; therefore, the doctor will prescribe antibiotics before dental or other surgery. After the first six months, this precaution is no longer necessary.
Remmy’s Story: Repairing Patent Ductus Arteriosus
When seven-year-old Remmy had occasional shortness of breath and seemed more tired than usual, it never occurred to his parents that he might have a problem with his heart.
Read the full story
Why choose the Children’s Heart Institute?
As part of the Children’s Heart Institute at Children’s Memorial Hermann Hospital, the affiliated cardiologists and affiliated cardiovascular surgeons collaborate as a multidisciplinary team to treat babies prior to birth, infants, children and young adults with congenital and acquired heart disorders. The team of affiliated physicians, nurses and coordinators work together with you to determine the best treatment plan for your child. Your child’s referring physician is also kept fully informed of your child’s treatment plan.
At Children’s Memorial Hermann Hospital, the affiliated cardiologists and affiliated cardiovascular surgeons understand the unique challenges, circumstances and intricacies of caring for young patients with heart conditions. In addition to the team’s medical expertise, Children’s Memorial Hermann Hospital provides families with patient-centered care, keeping families fully involved as part of the child’s treatment team as well as offering resources to meet the needs of your entire family.
Pediatric Cardiology Clinic
The University of Texas Health Science Center Professional Building
6410 Fannin, Suite 370
Houston, TX 77030
Phone: (713) 486-6755 (Appointment Line)
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Note: This page is meant to be a helpful, informative introduction on the subject of PDA in children. The information may not be applicable to all cases, especially if there are additional defects. It is not meant to replace the opinion of a personal physician.
03/2016 – This page was updated and approved by an affiliated pediatric physician at the Children’s Heart Institute.