Patent Ductus Arteriosus (PDA)

Patent ductus arteriosus symptoms vary with the size of the defect and whether the baby is full term or premature. A small PDA might cause no signs or symptoms and go undetected for some time — even until adulthood. A large PDA can cause signs of heart failure soon after birth.

Your baby's doctor might first suspect a heart defect during a regular checkup after hearing a heart murmur while listening to your baby's heart through a stethoscope.

A large PDA found during infancy or childhood might cause:

• Poor eating, which leads to poor growth
• Sweating with crying or eating
• Persistent fast breathing or breathlessness
• Easy tiring
• Rapid heart rate

Contact the doctor if your baby or older child:

• Tires easily when eating or playing
• Isn't gaining weight
• Becomes breathless when eating or crying
• Always breathes rapidly or is short of breath

Congenital heart defects arise from problems early in the heart's development — but there's often no clear cause. Genetic factors might play a role.

Before birth, a vascular connection (ductus arteriosus) between two major blood vessels leading from the heart — the aorta and pulmonary artery — is necessary for a baby's blood circulation. The ductus arteriosus diverts blood from a baby's lungs while they develop, and the baby receives oxygen from the mother's circulation.

After birth, the ductus arteriosus normally closes within two or three days. In premature infants, the connection often takes longer to close. If the connection remains open, it's referred to as a patent ductus arteriosus.

The abnormal opening causes too much blood to circulate to the baby's lungs and heart. Untreated, the blood pressure in the baby's lungs might increase (pulmonary hypertension) and the baby's heart might enlarge and weaken.

Risk factors

Risk factors for having a patent ductus arteriosus include:

• Premature birth. Patent ductus arteriosus (PDA) occurs more commonly in babies who are born too early than in babies who are born full term.
• Family history and other genetic conditions. A family history of heart defects and other genetic conditions, such as Down syndrome, increase the risk of having a PDA.
• Rubella infection during pregnancy. If you contract German measles (rubella) during pregnancy, your baby's risk of heart defects increases. The rubella virus crosses the placenta and spreads through the baby's circulatory system, damaging blood vessels and organs, including the heart.
• Being born at a high altitude. Babies born above 10,000 feet (3,048 meters) have a greater risk of a PDA than babies born at lower altitudes.
• Being female. PDA is twice as common in girls.

A small patent ductus arteriosus might not cause complications. Larger, untreated defects could cause:

• High blood pressure in the lungs (pulmonary hypertension). Too much blood circulating through the heart's main arteries through a patent ductus arteriosus can lead to pulmonary hypertension, which can cause permanent lung damage. A large patent ductus arteriosus can lead to Eisenmenger syndrome, an irreversible type of pulmonary hypertension.
• Heart failure. A patent ductus arteriosus can eventually cause the heart to enlarge and weaken, leading to heart failure, a chronic condition in which the heart can't pump effectively.
• Heart infection (endocarditis). People who have structural heart problems, such as a patent ductus arteriosus, are at a higher risk of an inflammation of the heart's inner lining (infectious endocarditis) than are people who have healthy hearts.

Patent ductus arteriosus and pregnancy

Most women who have a small patent ductus arteriosus can tolerate pregnancy without problems. However, having a larger defect or complications — such as heart failure, arrhythmias or pulmonary hypertension — can increase the risk of complications during pregnancy. If you have Eisenmenger syndrome, pregnancy should be avoided as it can be life-threatening.

If you have a heart defect, repaired or not, discuss family planning with your doctor. In some cases, preconception consultations with doctors who specialize in congenital cardiology, genetics and high-risk obstetric care are needed. Some heart medications can cause serious problems for a developing baby, and it might be necessary to stop or adjust the medications before you become pregnant.

There's no sure way to prevent having a baby with a patent ductus arteriosus. However, it's important to do everything possible to have a healthy pregnancy. Here are some of the basics:

• Seek early prenatal care, even before you're pregnant. Quitting smoking, reducing stress, stopping birth control — these are all things to talk to your doctor about before you get pregnant. Also discuss medications you're taking.
• Eat a healthy diet. Include a vitamin supplement that contains folic acid.
• Exercise regularly. Work with your doctor to develop an exercise plan that's right for you.
• Avoid risks. These include harmful substances such as alcohol, cigarettes and illegal drugs. Also avoid hot tubs and saunas.
• Avoid infections. Update your vaccinations before becoming pregnant. Certain types of infections can be harmful to a developing baby.
• Keep diabetes under control. If you have diabetes, work with your doctor to manage the condition before and during pregnancy.

If you have a family history of heart defects or other genetic disorders, consider talking with a genetic counsellor before becoming pregnant.

If the doctor suspects a heart defect, he or she might request one or more of the following tests:

• Echocardiogram. Sound waves produce images of the heart that can help the doctor identify a PDA, see if the heart chambers are enlarged, and judge how well the heart is pumping. This test also helps the doctor evaluate the heart valves and detect other potential heart defects.
• Chest X-ray. An X-ray image helps the doctor see the condition of your or your baby's heart and lungs. An X-ray might reveal conditions other than a heart defect, as well.
• Electrocardiogram. This test records the electrical activity of the heart, which can help the doctor diagnose heart defects or rhythm problems.
• Cardiac catheterization. This test isn't usually necessary for diagnosing a PDA alone, but it might be done to examine other congenital heart defects found during an echocardiogram or if a catheter procedure is being considered to treat a PDA. A thin, flexible tube (catheter) is inserted into a blood vessel at your or your child's groin or arm and guided through it into the heart. Through catheterization, the doctor may be able to do procedures to close the patent ductus arteriosus.

Treatments for patent ductus arteriosus depend on the age of the person being treated. Options might include:

• Watchful waiting. In a premature baby, a PDA often closes on its own. The doctor will monitor your baby's heart to make sure the open blood vessel is closing properly. For full-term babies, children and adults who have small PDAs that aren't causing other health problems, monitoring might be all that's needed.
• Medications. In a premature baby, nonsteroidal anti-inflammatory drugs (NSAIDs) — such as ibuprofen (Advil, Infant's Motrin, others) or indomethacin (Indocin) — might be used to help close a PDA. NSAIDs block the hormonelike chemicals in the body that keep the PDA open. NSAIDs won't close a PDA in full-term babies, children or adults.
• Surgical closure. If medications aren't effective and your child's condition is severe or causing complications, surgery might be recommended. A surgeon makes a small cut between your child's ribs to reach your child's heart and repair the open duct using stitches or clips.

After the surgery, your child will remain in the hospital for several days for observation. It usually takes a few weeks for a child to fully recover from heart surgery. Occasionally, surgical closure might also be recommended for adults who have a PDA that's causing health problems. Possible risks of the surgery include hoarseness, bleeding, infection and a paralyzed diaphragm.

• Catheter procedures. Premature babies are too small for catheter procedures. However, if your baby doesn't have PDA-related health problems, the doctor might recommend waiting until the baby is older to do a catheter procedure to correct the PDA. Catheter procedures can also be used to treat full-term babies, children and adults.

In a catheter procedure, a thin tube (catheter) is inserted into a blood vessel in the groin and threaded up to the heart. Through the catheter, a plug or coil is inserted to close the ductus arteriosus.

If the procedure is done on an outpatient basis, you or your child probably won't stay overnight in the hospital. Complications from catheter procedures include bleeding, infection, or movement of the plug or coil from where it was placed in the heart.

Preventive antibiotics

In the past, people who've had a PDA were advised to take antibiotics before dental work and certain surgical procedures, to prevent a heart infection (infective endocarditis). Today, preventive antibiotics are no longer recommended for most people with a patent ductus arteriosus.

You or your child may need to take preventive antibiotics the first six months after a catheter repair procedure, if there's still damage after the repair, or if you had infection in the heart previously. Talk to your doctor about whether you or your child needs to take antibiotics before any procedures.

Needed follow-up care

If you have PDA, even if you had surgery as a child, you may be at risk of developing complications as an adult. Therefore, it's important to have lifelong follow-up care, especially if you had corrective heart surgery.

This follow-up care could be as simple as having periodic checkups with your doctor, or it may involve regular screenings for complications. The important thing is to discuss your care plan with your doctor and make sure you follow all of your doctor's recommendations.

Ideally, a cardiologist trained in treating adults with congenital heart defects will manage your care.