Patent ductus arteriosus (PDA) is a congenital condition of the heart in which a blood vessel called the ductus arteriosus fails to close normally in an infant soon after birth.

Etiology

patent ductus arteriosus can be idiopathic (i.e. without an identifiable cause), or secondary to another condition. Some common contributing factors in humans include:Preterm birth
Congenital rubella syndrome
Chromosomal abnormalities such as Down syndrome
PDA affects girls more often than boys. The condition is more common in premature infants and those with neonatal respiratory distress syndrome. Infants with genetic disorders, such as Down syndrome, and whose mothers had rubella during pregnancy are at higher risk for PDA.

PDA is common in babies with congenital heart problems, such as hypoplastic left heart syndrome, transposition of the great vessels, and pulmonary stenosis.

Symptoms

A small PDA may not cause any symptoms. However, some infants may not tolerate a PDA, especially if it is large, and may have symptoms such as:
Bounding pulse
Fast breathing
Poor feeding habits
Shortness of breath
Sweating while feeding
Tiring very easily
Poor growth
Diagnostic Exams
Babies with PDA often have a characteristic heart murmur that can be heard with a stethoscope. However, in premature infants, a heart murmur may not be heard. Doctor’s 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.

Treatment

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 (though support in premature infants is mixed), wherein the DA is manually tied shut, or with intravascular coils or plugs that leads to formation of a thrombus in the DA.

A transcatheter device closure is a minimally invasive procedure that uses a thin, hollow tube. 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. Such endovascular coils have been used successfully as an alternative to surgery.

Surgery may be needed if the catheter procedure does not work or cannot be used. Surgery involves making a small cut between the ribs to repair the PDA.

Prognosis

Without treatments, the disease may progress from left-to-right (noncyanotic heart) shunt to right-to-left shunt (cyanotic heart) called Eisenmenger syndrome

Surgery carries its own significant risks. It may eliminate some of the problems of a PDA, but it can also introduce a new set of problems. The potential benefits and risks should be weighed carefully before choosing surgery.

Possible Complications

If the patent ductus is not closed, the infant has a risk of developing heart failure, pulmonary artery hypertension, or infective endocarditis — an infection of the inner lining of the heart.

Prevention

Preventing preterm deliveries, where possible, is the most effective way to prevent PDA.

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