Patent Ductus Arteriosus (PDA)

What is Patent Ductus Arteriosus?

The ductus arteriosus is a normal artery that is part of the fetal circulatory system. It connects the aorta and the pulmonary arteries, which are responsible for carrying blood to the body and to the lungs respectively. Since the fetus is supplied with oxygenated blood through the mother’s placenta, the ductus arteriosus allows the blood to bypass the baby’s lungs and go directly to the body. After the baby is born, they begin to use their lungs so the ductus is no longer necessary. It normally closes on its own within about two days after birth.

When the ductus arteriosus doesn’t close, it results in a patent (or “open”) ductus arteriosus (PDA). PDA allows the oxygen-rich blood from the aorta to mix with the oxygen-poor blood in the pulmonary artery. When the opening is large, this can result in too much blood flow to the lungs. This can put a strain on the heart, cause increased blood pressure and fluid buildup in the lungs, and lead to problems with breathing and feeding.

These are the most common symptoms of PDA:

• Bluish skin color from low oxygen levels (cyanosis)
• Fatigue
• Infections
• Heart murmur
• Poor weight gain
• Trouble doing activities (in older children)

Diagnosing PDA

Your child’s healthcare provider may notice signs of PDA shortly after birth by detecting a heart murmur or other symptoms during an exam. You may be referred to a pediatric cardiologist for further examination and testing. The cardiologist will listen to your baby’s hearts and lungs and may order tests such as:

Treatment for PDA

When a PDA is small enough that it doesn’t cause symptoms, it may not need to be treated. These minor openings may close on their own within a few months after birth. Your baby may need to take medication to help assist with the PDA’s closure or reduce the risk of fluid buildup.

However, if the PDA is large enough to cause severe symptoms or impact heart and lung function, intervention may be necessary. Procedures to correct PDA include:

Cardiac catheterization: In this minimally invasive procedure, a pediatric heart specialist will insert a catheter (a thin, flexible tube) into a blood vessel in the leg or groin through a tiny incision. They will then guide the catheter up to the site of the PDA and slide a closure device or coil through the catheter into the PDA. This will close off the opening and stop blood from flowing throw it.

Surgery: The majority of babies with PDA will be able to be treated with cardiac catheterization alone. Surgery is usually only used on babies with other heart defects in addition to PDA. During this procedure, the pediatric cardiothoracic surgeon will use stitches or clips to close off the PDA and stop blood flow.

All procedures to treat PDA are performed in our state-of-the-art hybrid catheterization and surgical suites. Our facility offers cutting-edge technology, including the most advanced imaging available worldwide and 3-D capabilities. This helps our surgeons better understand and visualize each patient’s unique anatomy while making complex repairs, leading to improved patient safety and outcomes.

Follow-up Care

If your child undergoes surgery, they will recover in the state-of-the-art pediatric cardiac intensive care unit (PCICU) at UH Rainbow, where they will be closely monitored by a team of pediatric cardiac intensive care medicine experts and will have access to other pediatric specialists as needed. As they recover, your child will transition from the PCICU to the pediatric cardiac stepdown unit, where they will receive continuity of care by specially trained staff. Before discharge, our cardiac nursing staff will work with families to set up follow-up appointments, educate them on how to care for their child once they return home, and ensure they have the necessary equipment and supplies.

After PDA repair, your child’s doctor may give you special instructions for feeding and giving any medications. As your child recovers, they will regain energy, and feeding and weight gain problems will improve. Older children who undergo PDA repair will be able to return to regular activities and live normal, active lives in the weeks and months following their procedure.