Pediatric Patent Ductus Arteriosus

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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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.

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.

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.

At Children’s Heart Institute at Children’s Memorial Hermann Hospital, patients with congenital or acquired heart disorders receive hands-on specialized care 24/7 from a team of affiliated physicians and specialty-trained nurses who aim to deliver the best possible outcomes.

Children’s Memorial Hermann Hospital was named one of the top children's hospitals nationally in Cardiology & Heart Surgery by U.S. News & World Report. In addition, Children’s Heart Institute is among the top congenital heart surgery programs in North America for patient care and outcomes, according to the Fall 2019 Society of Thoracic Surgeons (STS) Congenital Heart Surgery Database Report of 118 STS participating programs.

In collaboration with various subspecialties, the affiliated team provides comprehensive care for newborns, children and adolescents, with the ability to transition into adult congenital cardiac care. Team members have the experience and skills necessary to offer innovative treatment methods and specialized services, including, but not limited to:

• Biventricular repairs and biventricular conversions
• Congenital heart optimization
• Full repairs for complex congenital heart defects in newborns
• Hybrid catheterization and surgical procedures
• Minimally invasive transcatheter pulmonary valve (TPV) therapy
• Minimally invasive repairs
• Treatment for adult congenital heart disease
• Valve repairs and preservation

With the Level IV Neonatal Intensive Care Unit (NICU) and a dedicated Children’s Heart Institute Intensive Care Unit at Children’s Memorial Hermann Hospital, critical heart patients have access to quality, specialized care. By utilizing state-of-the-art techniques, the team at Children’s Heart Institute strives to offer patients with the most complex problems the greatest opportunity for a normal life.

If you have any questions, use the online tool below to help us connect with you. To refer a patient or schedule an appointment, please contact our clinic using the information below.

• 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)
   
• Pediatric and Congenital Heart Surgery Clinic
  The University of Texas Health Science Center Professional Building
  6410 Fannin, Suite 370
  Houston, TX 77030
  Phone: (713) 500-5746
  CMHH-Heart@memorialhermann.org

The Children’s Heart Institute is a collaboration between the affiliated physicians at McGovern Medical School at UTHealth Houston and Children’s Memorial Hermann Hospital. Typically, patients are seen on an outpatient basis at a UT Physicians clinic with all inpatient procedures performed at Children’s Memorial Hermann Hospital.