Patent ductus arteriosus (PDA)

Patent ductus arteriosus (PDA) is a persistent opening between the two major blood vessels leading from the heart.

An opening called the ductus arteriosus is part of the blood flow system in the womb for an unborn baby, also called a fetus. It usually closes shortly after birth. If the opening remains open, it’s called a patent ductus arteriosus. A PDA is a type of congenital heart defect.

A small PDA might never need treatment. But a large, untreated patent ductus arteriosus can let oxygen-poor blood move the wrong way. This can make the heart muscle weak, causing heart failure and other complications.

Treatments for patent ductus arteriosus may include regular health checkups, medicines, and a procedure or surgery to close the opening.

Patent ductus arteriosus symptoms (PDA) depend on the size of the opening and the person’s age. A small PDA might not cause symptoms. Some people don’t notice symptoms until adulthood. A large PDA can cause symptoms of heart failure soon after birth.

A large PDA found during infancy or childhood might cause:

• Poor eating, which leads to poor growth.
• Sweating with crying or eating.
• Constant fast breathing or being out of breath.
• Easy tiring.
• Rapid heart rate.

When to see a doctor

Contact a healthcare professional if your baby or older child:

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

The exact causes of patent ductus arteriosus and other congenital heart defects are not clear. During the first six weeks of pregnancy, an unborn baby’s heart starts to form and beat. The major blood vessels to and from the heart grow. It’s during this time that certain congenital heart defects may begin to develop.

Before birth, there is a temporary opening called the ductus arteriosus between the two main blood vessels leaving a baby’s heart. Those vessels are the aorta and the pulmonary artery. The opening is needed for a baby’s blood flow before birth. It moves blood away from a baby’s lungs while they develop. The baby gets oxygen from the mother’s blood.

After birth, the ductus arteriosus is no longer needed. It usually closes within 2 to 3 days. But in some infants, the opening doesn’t close. When it stays open, it’s called a patent ductus arteriosus.

The constant opening causes too much blood to flow to the baby’s lungs and heart. Untreated, the blood pressure in the baby’s lungs might increase. The baby’s heart might grow larger and get weak.

Risk factors for patent ductus arteriosus (PDA) include:

• Premature birth. Patent ductus arteriosus 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 conditions present at birth may increase the risk of PDA. Babies born with an extra chromosome 21, a condition called Down syndrome, also are more likely to have patent ductus arteriosus.
• German measles during pregnancy. Having German measles, also called rubella, during pregnancy can cause changes in an unborn baby’s heart. A blood test done before pregnancy can tell if you’re immune to rubella. A vaccine is available for those who aren’t immune.
• Being born at a high altitude. Babies born above 8,200 feet (2,499 meters) have a greater risk of PDA than babies born at lower altitudes.
• Female sex assigned at birth. Patent ductus arteriosus is twice as common in girls.

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

• High blood pressure in the lungs, also called pulmonary hypertension. A large PDA causes irregular blood flow in the heart and lungs. As a result, pressure goes up in the pulmonary artery. Over time, the increased pressure damages the smaller blood vessels in the lungs. A life-threatening and lasting type of lung damage called Eisenmenger syndrome may occur.
• Heart failure. Symptoms of this serious complication include rapid breathing, often with gasping breaths, and poor weight gain.
• Heart infection, called endocarditis. Patent ductus arteriosus can increase the risk of germs attaching to areas in the heart. Without quick treatment, endocarditis can damage or destroy the heart valves.

Patent ductus arteriosus and pregnancy

It may be possible to have a successful pregnancy with a small patent ductus arteriosus. However, having a large PDA or a complication such as heart failure, lung damage or irregular heartbeats increases the risk of serious complications during pregnancy.

Before becoming pregnant, talk with your healthcare professional about possible pregnancy risks and complications. Some heart medicines can be dangerous for an unborn baby. Your healthcare professional may stop or change your medicines before you become pregnant.

Together you can plan for any special care needed during pregnancy. If you are at high risk of having a baby with a heart condition present at birth, genetic testing and screening may be done during pregnancy.

There is no known prevention for patent ductus arteriosus. However, it’s important to do everything possible to have a healthy pregnancy. Here are some of the basics:

• Get early prenatal care, even before you’re pregnant. If you’re thinking about pregnancy, talk with your healthcare team to develop a prenatal care plan. Also tell your healthcare professional about all the medicines you take, including those bought without a prescription.
• Start taking folic acid. Taking 400 micrograms of folic acid daily before and during pregnancy has been shown to reduce brain and spinal cord conditions in the baby. It also may help reduce the risk of heart conditions.
• Exercise and stay active. Work with your healthcare professional to develop an exercise plan that’s right for you.
• Do not drink alcohol or smoke. These lifestyle habits can harm a baby’s health. Also avoid secondhand smoke.
• Get recommended vaccines. Update your vaccinations before becoming pregnant. Certain types of infections can be harmful to a developing baby.
• Control blood sugar. If you have diabetes, good control of your blood sugar may reduce the risk of certain heart conditions present at birth in your baby.

To diagnose patent ductus arteriosus (PDA), a healthcare professional does a physical exam and asks questions about you or your child’s medical history. The healthcare professional may hear a heart sound called a murmur while listening to the heart with a stethoscope.

Tests

Tests can help diagnose patent ductus arteriosus.

• Echocardiogram. Sound waves make pictures of the beating heart. This test shows how blood flows through the heart and heart valves. It can tell if there is a persistent opening in the heart. An echocardiogram also can tell if there are higher pressures in the lung arteries.
• Chest X-ray. This test shows the condition of the heart and lungs.
• Electrocardiogram (ECG or EKG). This quick and simple test records the electrical signals that make up the heartbeat. It shows how fast or how slow the heart is beating.
• Cardiac catheterization. This test isn’t usually needed to diagnose patent ductus arteriosus. But it might be done if there also are other heart conditions. A doctor places a thin, flexible tube called a catheter into a blood vessel, usually in the groin or wrist, and guides it to the heart. During this test, treatments may be done to close the patent ductus arteriosus.

Treatments for patent ductus arteriosus (PDA) depend on the age of the person being treated.

Some people with small PDAs may only need regular health checkups to watch for complications. A premature baby born with patent ductus arteriosus also needs regular checkups to make sure the opening closes.

Medications

A premature baby born with patent ductus arteriosus (PDA) may get medicines called nonsteroidal anti-inflammatory drugs. These medicines, also called NSAIDs, block certain body chemicals that keep the PDA open. However, these medicines won’t close a PDA in full-term babies, children or adults.

In the past, healthcare professionals told people born with patent ductus arteriosus to take antibiotics to prevent infection before dental work and some surgeries. This is no longer recommended for most people with patent ductus arteriosus. Ask your healthcare professional whether preventive antibiotics are necessary. They might be recommended after certain heart procedures.

Surgery or other procedures

Treatments to close a patent ductus arteriosus include:

• Using a thin tube called a catheter and a plug or coil to close the opening. This treatment is called a catheter procedure. It lets a doctor repair the opening without open-heart surgery.

  To do this treatment, the doctor places the catheter into a blood vessel in the groin and guides it to the heart. A plug or coil goes through the catheter. The plug or coil closes the patent ductus arteriosus. The treatment doesn’t usually need an overnight hospital stay.

  Premature babies are too small for catheter treatments. If the PDA isn’t causing trouble, a catheter treatment to close the opening may be done when the baby is older.

• Open-heart surgery to close the PDA. This treatment is called surgical closure. It may be needed if medicine doesn’t work or if the PDA is large or causing complications.

  A surgeon makes a small cut between the ribs to reach the heart. The PDA is closed using stitches or clips. It usually takes a few weeks to fully recover from this surgery.

Some people born with PDA need regular health checkups for life, even after treatment to close the opening. During these checkups, a healthcare professional may do tests to check for complications. Talk with your healthcare professional about your care plan. Ideally, it’s best to seek care from a doctor trained in treating adults with heart conditions before birth. This type of doctor is called a congenital cardiologist.

Anyone born with a patent ductus arteriosus needs to take steps to keep the heart healthy and prevent complications. These tips can help.

• Don’t smoke. Smoking is a major risk factor for heart disease and other heart conditions. Quitting is the best way to reduce the risk. If you need help quitting, talk with your healthcare professional.
• Eat healthy foods. Eat plenty of fruits, vegetables and whole grains. Limit sugar, salt and saturated fats.
• Practice good hygiene. Regularly wash your hands and brush and floss your teeth to keep yourself healthy.
• Ask about sports limits. Some people born with heart conditions may be told not to do some types of exercise or sports activities. Ask your healthcare professional which sports and types of exercise are safe for you or your child.
• Manage stress. Find ways to help reduce emotional stress. Some tips are to get more exercise, practice mindfulness and connect with others in support groups. If you have anxiety or depression, talk with your healthcare professional about treatments that can help.

A large patent ductus arteriosus or one that’s causing serious health concerns may be diagnosed immediately at birth. But some smaller ones might not be found until later in life. If you have a PDA, you may be referred to a doctor trained in heart conditions present at birth. This type of doctor is called a congenital cardiologist. A doctor with training in kids’ heart conditions is called a pediatric cardiologist.

Here’s some information to help you get ready for your appointment.

What you can do

• Be aware of restrictions before the appointment. When you make the appointment, ask if there’s anything you need to do in advance, such as not drink or eat before certain tests.
• Write down the symptoms, including any that might not seem related to patent ductus arteriosus or another heart condition.
• Write down important personal information, including any family history of heart conditions.
• Bring copies of past medical records, including reports from previous treatments or tests.
• Make a list of the medicines, vitamins and supplements that you or your child takes. Include the dosages.
• Take someone along, if possible. Someone who goes with you can help you remember information you’re given.
• Write down questions to ask the healthcare professional.

For patent ductus arteriosus, questions to ask include:

• Is the PDA causing complications?
• What tests are needed?
• Will I or my child need surgery?
• Should I or my child see a doctor trained in congenital heart defects?
• Is this condition passed down through families? If I have other children, how likely are they to have PDA?
• Do I need to limit my or my child’s activities?
• Is there any information that I can take home with me? What websites do you recommend?

Don’t hesitate to ask other questions.

What to expect from your doctor

The healthcare professional is likely to ask many questions, such as:

• When did you notice the symptoms?
• Are the symptoms always there or do they come and go?
• How bad are the symptoms?
• What, if anything, makes the symptoms better?
• What, if anything, makes the symptoms worse?
• What medicines have you or your child taken to treat the condition? What surgeries have you or your child had?