Patent Ductus Arteriosus (PDA)
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Patent ductus arteriosus (PDA) is a congenital heart defect in which there is a persistent opening between the two major blood vessels leading from the heart. Normally, the opening called the ductus arteriosus closes shortly after birth. However, if it remains open, it’s called a patent ductus arteriosus.
While a small PDA often does not cause problems and may not require treatment, a large, untreated PDA can lead to complications such as heart failure. This is because it allows oxygen-poor blood to move in the wrong direction, weakening the heart muscle.
Healthcare providers may use different treatment options for PDA, including regular health checkups, medication, and procedures or surgery to close the opening. In some cases, PDA may resolve on its own. However, if it persists, healthcare providers aim to restore normal blood circulation between the heart and lungs.
Symptoms
The symptoms of patent ductus arteriosus (PDA) vary depending on the size of the opening and the age of the person. If the PDA is small, there may be no symptoms, and some individuals may not experience any symptoms until they reach adulthood. However, if the PDA is large, it can lead to symptoms of heart failure shortly after birth.
A significant PDA discovered during infancy or childhood could lead to:
- Gets tired easily.
- Fast heartbeat or pulse.
- Perspiring when sobbing or eating.
- Inadequate nutrition which results in stunted growth.
- Consistently rapid breathing or being out of breath.
If your baby or older child is experiencing symptoms such as easily getting tired during meals or playtime, not gaining weight, becoming breathless while eating or crying, or consistently displaying rapid breathing or difficulty breathing, it is recommended to seek medical attention from a doctor.
Causes
Congenital heart defects are not fully understood, but they can occur during the first six weeks of pregnancy when the baby’s heart begins to form and beat, and the major blood vessels to and from the heart develop. Some heart defects may develop during this time, but the exact causes remain unclear.
During pregnancy, the baby’s heart has a temporary opening called the ductus arteriosus, which is between the two main blood vessels leaving the heart. This opening is essential for the baby’s blood flow before birth, allowing the blood to bypass the lungs while they develop. The mother’s blood supplies the baby with oxygen. Normally, the ductus arteriosus closes within 2 to 3 days after birth, but in some cases, it remains open, causing a condition called a patent ductus arteriosus.
If left untreated, a patent ductus arteriosus can cause too much blood to flow to the baby’s lungs and heart. The blood pressure in the lungs may increase, and the baby’s heart may enlarge and weaken. Therefore, it is crucial to detect and treat a patent ductus arteriosus to prevent further complications.
Risk factors
The following are risk factors for patent ductus arteriosus (PDA):
- Premature birth. Compared to newborns born at full term, premature babies are more likely to have patent ductus arteriosus.
- Having PDA or other genetic disorders in the family. The risk of developing a PDA (Patent Ductus Arteriosus) may be higher if there is a history of heart problems in the family from birth. Additionally, infants who have Down syndrome, which involves an extra 21st chromosome, are more likely to develop this condition.
- German measles during pregnancy. Pregnancy-related rubella, often known as German measles, can interfere with a baby’s ability to form a heart. You can find out if you are immune to rubella by having a blood test before becoming pregnant. For people who lack immunity, there is a vaccination available.
- Altitude of the birth place. Infants born at higher altitudes—above 8,200 feet (2,499 meters)—have a higher risk of developing PDA.
- Gender. In girls, patent ductus arteriosus occurs twice as frequently.
Diagnosis
During a physical examination, the healthcare provider will inquire about your medical history and perform a physical evaluation. While using a stethoscope to listen to your heart, the provider might detect a heart sound known as a murmur.
The following examinations could be performed to identify patent ductus arteriosus:
- Echocardiogram. In this examination, the heart’s beating is visualized using sound waves. It demonstrates the movement of blood through the heart, heart valves, and surrounding blood arteries. The results of the test let your doctor know how well your heart is pumping blood. A patent ductus arteriosus may be seen. Moreover, a lung artery echocardiography can find increased pressures there.
- Chest X-ray. This examination reveals the health of the lungs and heart.
- Electrocardiogram. The heartbeat’s electrical signals are captured during this quick and easy test. It demonstrates how quickly or slowly the heart is beating.
- Cardiac catheterization. The diagnosis of a PDA typically does not require this test. Yet if a PDA emerges along with other heart issues, it might be done. The heart is reached by inserting a long, thin, flexible tube (catheter) into a blood artery, typically in the groin or wrist. The medical professional might be able to do therapies to seal the patent ductus arteriosus during this test.
Treatment
Depending on the patient’s age, several treatments are used for patent ductus arteriosus. Some persons with mild PDAs who aren’t having issues merely require routine medical exams to look out for complications. If a preterm infant has a PDA, the doctor will check on them frequently to make sure it closes.
Medications
Premature babies with a patent ductus arteriosus (PDA) can be treated with nonsteroidal anti-inflammatory drugs (NSAIDs) to close the PDA by blocking specific body chemicals. However, NSAIDs are ineffective in closing PDAs in children and adults born at full term. In the past, individuals born with PDA were advised to take antibiotics before undergoing certain surgical or dental procedures to prevent heart infections. But nowadays, most people with PDA do not require preventive antibiotics, and their health care provider can determine if they need antibiotics after undergoing specific heart procedures.
Surgical intervention and other treatments
The following are cutting-edge methods for sealing a patent ductus arteriosus:
- Catheter procedure. Enclosing the opening with a plug or coil and a thin tube known as a catheter. It makes a repair possible without requiring open heart surgery.
A small tube is inserted into a blood artery in the groin and sent to the heart during a catheterization operation. The catheter is passed through by a plug or coil. The ductus arteriosus is sealed off by the coil or stopper. Most of the time, no overnight hospital stay is necessary for the treatment.
Babies born too early are too little to receive catheter treatments. When the baby is older, a catheter therapy to close the opening may be performed if the PDA is not posing any issues.
- Surgical closure. Closing the PDA with open cardiac surgery. If medication is ineffective if the PDA is big or producing issues, heart surgery may be required.
In order to access the child’s heart, a surgeon creates a small incision between the ribs. Stitches or clips are used to seal the opening. A child often needs a few weeks to recuperate entirely from this operation.
Even after receiving therapy to close the opening, some people born with a PDA require ongoing medical examinations. The doctor performing these examinations may order tests to look for problems. Discuss your treatment strategy with your healthcare practitioner. Prenatal care from a professional with experience in treating people with cardiac issues is ideal. Congenital cardiologists are this category of medical professional.
