What are the other Names for this Condition? (Also known as/Synonyms)

• Patency of the Ductus Arteriosus
• Patent Arterial Duct
• Persistierender Ductus Arteriosus

What is Patent Ductus Arteriosus? (Definition/Background Information)

• Patent Ductus Arteriosus (PDA) is a congenital heart defect found in newborn babies characterized by a failure of the ductus arteriosus to close after birth
• The ductus arteriosus is a fetal blood vessel that connects the aorta and pulmonary artery, which helps to carry blood away from the heart in a developing fetus. It sends blood directly to the body, while not allowing it to reach the lungs
• During fetal development, blood circulation mainly occurs through the ductus arteriosus. The fetal lungs do not have any role to play in blood oxygenation; the fetus gets oxygen directly from the mother. But, once the baby is born and begins to breathe through its lungs, the ductus arteriosus is no longer needed. Thus, it spontaneously closes within a couple of days of birth
• In certain cases, this ductus arteriosus fails to close and cause oxygen-rich blood to mix with oxygen-poor blood in the pulmonary artery. This results in too much flow of blood into the lungs, straining the heart and increasing the blood pressure. This condition is termed as Patent Ductus Arteriosus, where the ductus arteriosus remains ‘patent’ or open
• The exact cause of this heart disorder is unknown, but the incidence of PDA is more common among premature neonates (newborns)
• The common signs and symptoms associated with PDA include breathing-related problems, bluish discoloration of the skin, sweating while feeding, and poor growth and development
• The various treatment options available for Patent Ductus Arteriosus include medications, such as indomethacin, catheter procedures, and open heart surgeries
• The prognosis is generally good with early diagnosis and appropriate treatment

Who gets Patent Ductus Arteriosus? (Age and Sex Distribution)

• Patent Ductus Arteriosus is a congenital condition that is present at birth. The incidence rate is estimated at:
  • 8 out of every 1000 premature babies may be affected
  • 2 out of every 1000 full-term born (normal) babies may be affected          
• The incidence is more common in girls than in boys, in the ratio of 3:1
• No geographical, racial, or ethnic predominance is seen
• PDA accounts for 5-10% of all congenital heart diseases in infants

What are the Risk Factors for Patent Ductus Arteriosus? (Predisposing Factors)

The risk factors for Patent Ductus Arteriosus include:

• Premature, preterm babies
• Infants with genetic disorders such as Down syndrome
• Infants, whose mother had an attack of rubella infection during pregnancy
• Family history of PDA
• Gender - being female
• Born at a high altitude i.e., 10,000 feet above sea level
• The presence of other heart defects such as hypoplastic left heart syndrome, transposition of the great vessels, and pulmonary stenosis

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Patent Ductus Arteriosus? (Etiology)

• Patent Ductus Arteriosus (PDA) could be idiopathic (occurring without any identifiable cause), or secondary to some other medical condition
• PDA can be associated with other congenital heart abnormalities, or it may arise on its own. The condition can be significant or insignificant, depending on the size of the lumen. Insignificant PDAs do not cause any signs and symptoms
• It is generally believed that certain health conditions or problems that occur in the baby’s heart during the fetal developmental stage could be a possible cause

Some common causes for the occurrence of Patent Ductus Arteriosus could be:

• Preterm birth: Birth of the baby before 37 weeks gestational age
• Congenital rubella syndrome: This condition can occur when the expectant mother contracts rubella infection, during the early stages of her pregnancy
• Certain chromosomal abnormalities that lead to various medical conditions such as Down syndrome
• Certain congenital heart conditions could also occur with PDA that include:
  • Hypoplastic left heart syndrome: It is a congenital heart disease characterized by an underdevelopment of the left ventricle of the heart
  • Transposition of the great vessels: It is a rare, congenital heart defect in which the two main arteries leaving the heart are reversed, changing the manner in which blood circulates in the body
  • Pulmonary valve stenosis: Arising due to a deformity in or at the pulmonary valve    
• Genetic and environmental factors do play an important role in the occurrence of Patent Ductus Arteriosus. A defect in one or more genes could lead to this condition, though the exact gene(s) has still not been identified
• Persistent high levels of prostaglandins (that are responsible for keeping the ductus arteriosus open) can also lead to PDA

What are the Signs and Symptoms of Patent Ductus Arteriosus?

A small-sized PDA will not exhibit any symptoms and may even go unnoticed. But, a large-sized PDA can lead to serious complications such as heart failure.

The common signs and symptoms of Patent Ductus Arteriosus include:

• Poor appetite, poor growth
• Sweating while feeding
• Rapid breathing, dyspnea or shortness of breath
• Lethargy and weakness
• Tachycardia or fast heart rate
• Heart murmur: Extra or unusual sound may be heard, while the heart is beating
• Cardiomegaly or enlargement of the heart
• Cyanosis or bluish discoloration of the skin
• Strong and forceful pulse, rapid increase in the pulse pressure

How is Patent Ductus Arteriosus Diagnosed?

The diagnosis of Patent Ductus Arteriosus may include:

• The main step towards diagnosing Patent Ductus Arteriosus is to listen to the murmur sound (extra or unusual sounds heard during heartbeat) in the baby’s heart through a stethoscope. This murmur sound may not be heard in premature babies
• The healthcare provider will suspect a PDA, if symptoms, such as feeding difficulties and breathing abnormalities, exist immediately after birth

The diagnostic exams and tests for PDA may include:

• Chest X-rays will reveal the changes and conditions of the heart and lungs
• An echocardiogram produces images of the heart using sound waves; it can help confirm the diagnosis. The electrocardiogram records the electrical activity of the heart; it can bring to light any heart defects or problems associated with the heart rhythm
• Cardiac angiography
• CT scan and MRI scan may also be helpful in the diagnosis of PDA

The Patent Ductus Arteriosus can be large or small. When PDA is small, it may go unnoticed until late childhood.

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Patent Ductus Arteriosus?

Complications due to Patent Ductus Arteriosus could possibly include:

• Pulmonary hypertension (high blood pressure in the lungs)
• Heart failure
• Endocarditis: Bacterial infection of the heart valves or inner linings of the heart
• Arrhythmia or irregular heartbeat

How is Patent Ductus Arteriosus Treated?

The earlier the treatment is administered, the better is the outcome. Insignificant Patent Ductus Arteriosus do not require any treatment; sometimes, they close on their own. In premature (pre-term) babies, typically the ductus arteriosus closes within the first 2 years of life. However, in full-term babies, automatic closing of the ductus arteriosus is very rare.

The various treatment procedures that may be adopted to treat Patent Ductus Arteriosus may include:

• Use of medication: Non-steroidal anti-inflammatory drugs, such as indomethacin and special forms of ibuprofen, have proven to be effective
• Medical procedures used to treat PDA may include:
  • Transcatheter device closure procedure: A thin hollow tube or catheter is placed inside the blood vessel. A small metal coil is inserted through the catheter to the site of the PDA, which will help in blocking the blood flow through the vessel
  • Surgery: An open heart surgery may be recommended when the catheter procedure is not effective. In this procedure, a small cut is made between the ribs to repair the ductus arteriosus
• Lifestyle and home remedies may include:
  • Avoiding infection: Children suffering from PDA need to regularly brush and floss their teeth, and also have regular dental check-ups to prevent any oral infection
  • Exercise and play: Even though children with heart defects may have to restrain themselves from vigorous physical activities, a certain amount of exercise and play can be a part of their life, which may be done in consultation with the healthcare provider          

How can Patent Ductus Arteriosus be Prevented?

As the exact cause of Patent Ductus Arteriosus is currently unknown, preventative methods for PDA do not exist. However the following factors may help in reducing the risk of Patent Ductus Arteriosus (especially during pregnancy):

• Early prenatal care, even before pregnancy, can be beneficial in preventing PDA
• Taking a balanced diet containing vitamin supplements and folic acid is necessary throughout the pregnancy period
• Avoid the use of harmful substances such as alcohol, cigarettes, and illegal drugs
• Check with your healthcare provider concerning all the necessary vaccinations that should be administered before pregnancy to prevent infections
• Keep diabetes under control, before and after getting pregnant
• When a family history of heart defects and genetic disorder is observed, genetic counseling is advised

What is the Prognosis of Patent Ductus Arteriosus? (Outcomes/Resolutions)

• With proper diagnosis, treatment, and medications, the prognosis for Patent Ductus Arteriosus is excellent. Children usually live a healthy normal life after treatment
• Insignificant PDAs have excellent prognosis too, since they resolve on their own and no treatment is usually necessary
• Without treatment the heart disorder may result in Eisenmenger’s syndrome. It is a congenital heart defect characterized by the presence of a hole between two chambers of the heart causing abnormal flow of blood in the heart and lungs
• Without proper treatment, PDA can also lead to long-term complications, such as pulmonary hypertension, which may necessitate the need for a lung or a heart transplant

Additional and Relevant Useful Information for Patent Ductus Arteriosus:

• Ductus arteriosus closure procedure involves surgically closing the ductus arteriosus, which is a blood vessel that connects the aorta and pulmonary artery

The following article link will help you understand the ductus arteriosus closure surgical procedure:

http://www.dovemed.com/common-procedures/procedures-surgical/ductus-arteriosus-closure/