Patent ductus arteriosis (PDA) - series?

Answer 1

Definition

Patent ductus arteriosus (PDA) is a condition in which a blood vessel called the ductus arteriosus fails to close normally in an infant soon after birth. (The word "patent" means open.)

The condition leads to abnormal blood flow between the aorta and pulmonary artery, two major blood vessels that carry blood from the heart.

Alternative Names

PDA

Causes, incidence, and risk factors

Before birth, the ductus arteriosus allows blood to bypass the baby's lungs by connecting the pulmonary arteries (which supply blood to the lungs) with the aorta (which supplies blood to the body). Soon after the infant is born and the lungs fill with air, this blood vessel is no longer needed. It will usually close within a couple of days. If the ductus arteriosus does not close, there will be abnormal blood circulation between the heart and lungs.

PDA affects girls more often than boys. The condition is more common in prematureinfants and those with neonatal respiratory distress syndrome. Infants with genetic disorders, such as Down syndrome, and whose mothers had rubella during pregnancy are at higher risk for PDA.

PDA is common in babies with congenital heart problems, such as hypoplastic left heart syndrome, transposition of the great vessels, and pulmonary stenosis.

Symptoms

A small PDA may not cause any symptoms. However, some infants may not tolerate a PDA, especially if it is large, and may have symptoms such as:

• Bounding pulse
• Fast breathing
• Poor feeding habits
• Shortness of breath
• Sweating while feeding
• Tiring very easily
• Poor growth

Signs and tests

Babies with PDA often have a characteristic heart murmur that can be heard with a stethoscope. However, in premature infants, a heart murmur may not be heard. Doctor's may suspect the condition if the infant has breathing or feeding problems soon after birth.

Changes may be seen on chest x-rays. The diagnosis is confirmed with an echocardiogram.

Sometimes, a small PDA may not be diagnosed until later in childhood.

Treatment

The goal of treatment, if the rest of circulation is normal or close to normal, is to close the PDA. In the presence of certain other heart problems, such as hypoplastic left heart syndrome, the PDA may actually be lifesaving and medicine may be used to prevent it from closing.

Sometimes, a PDA may close on its own. Premature babies have a high rate of closure within the first 2 years of life. In full-term infants, a PDA rarely closes on its own after the first few weeks.

When treatment is appropriate, medications such as indomethacin or a special form of ibuprofen are generally the first choice.

If these measures do not work or can't be used, a medical procedure may be needed.

A transcatheter device closure is a minimally invasive procedure that uses a thin, hollow tube. The doctor passes a small metal coil or other blocking device through the catheter to the site of the PDA. This blocks blood flow through the vessel. Such endovascular coils have been used successfully as an alternative to surgery.

Surgery may be needed if the catheter procedure does not work or cannot be used. Surgery involves making a small cut between the ribs to repair the PDA.

Expectations (prognosis)

If a small PDA remains open, heart symptoms may or may not eventually develop. Persons with a moderate or large PDA could eventually develop heart problems unless the PDA is closed.

Closure with medications can work very well in some situations, with few side effects. Early treatment with medications is more likely to be successful.

Surgery carries its own significant risks. It may eliminate some of the problems of a PDA, but it can also introduce a new set of problems. The potential benefits and risks should be weighed carefully before choosing surgery.

Complications

If the patent ductus is not closed, the infant has a risk of developing heart failure, pulmonary artery hypertension, or infective endocarditis -- an infection of the inner lining of the heart.

Calling your health care provider

This condition is usually diagnosed by a doctor examining your infant. Breathing and feeding problems in an infant can occasionally be due to an undiagnosed PDA.

Prevention

Preventing preterm deliveries, where possible, is the most effective way to prevent PDA.

References

Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 8th ed. St. Louis, Mo; WB Saunders; 2007.

Answer 2

Definition

Patent ductus arteriosus (PDA) is a condition in which the ductus arteriosus does not close. (The word "patent" means open.)

The ductus arteriosus is a blood vessel that allows blood to go around the baby's lungs before birth. Soon after the infant is born and the lungs fill with air, the ductus arteriosus is no longer needed. It usually closes in a couple of days after birth.

PDA leads to abnormal blood flow between the aorta and pulmonary artery, two major blood vessels that carry blood from the heart.

Alternative Names

PDA

Causes, incidence, and risk factors

PDA affects girls more often than boys. The condition is more common in prematureinfants and those with neonatal respiratory distress syndrome. Infants with genetic disorders, such as Down syndrome, and whose mothers had rubella during pregnancy are at higher risk for PDA.

PDA is common in babies with congenital heart problems, such as hypoplastic left heart syndrome, transposition of the great vessels, and pulmonary stenosis.

Symptoms

A small PDA may not cause any symptoms. However, some infants may have symptoms such as:

• Fast breathing
• Poor feeding habits
• Rapid pulse
• Shortness of breath
• Sweating while feeding
• Tiring very easily
• Poor growth

Signs and tests

Babies with PDA often have a heart murmur that can be heard with a stethoscope. However, in premature infants, a heart murmur may not be heard. The health care provider may suspect the condition if the infant has breathing or feeding problems soon after birth.

Changes may be seen on chest x-rays. The diagnosis is confirmed with an echocardiogram.

Sometimes, a small PDA may not be diagnosed until later in childhood.

Treatment

If the rest of the baby's heart and blood flow is normal or close to normal, the goal is to close the PDA. If the baby has certain other heart problems or defects, keeping the ductus arteriosus open may be lifesaving. Medicine may be used to stop it from closing.

Sometimes, a PDA may close on its own. In premature babies it often closes within the first 2 years of life. In full-term infants, a PDA rarely closes on its own after the first few weeks.

When treatment is needed, medications such as indomethacin or a special form of ibuprofen are often the first choice. Medicines can work very well for some newborns, with few side effects. The earlier treatment is given, the more likely it is to succeed.

If these measures do not work or can't be used, the baby may need to have a medical procedure.

A transcatheter device closure is a procedure that uses a thin, hollow tube placed into a blood vessel. The doctor passes a small metal coil or other blocking device through the catheter to the site of the PDA. This blocks blood flow through the vessel. These coils can help the baby avoid surgery.

Surgery may be needed if the catheter procedure does not work or it cannot be used. Surgery involves making a small cut between the ribs to repair the PDA. Surgery has risks, however. Weigh the possible benefits and risks with your health care provider before choosing surgery.

Expectations (prognosis)

If a small PDA stays open, the baby may eventually develop heart symptoms. Babies with a larger PDA could develop heart problems such as heart failure, high blood pressure in the arteries of the lungs, or an infection of the inner lining of the heart if the PDA does not close.

Calling your health care provider

This condition is usually diagnosed by the health care provider who examines your infant. Breathing and feeding problems in an infant can sometimes be due to a PDA that has not been diagnosed.

References

Webb GD, Smallhorn JF, Therrien J, Redington AN. Congenital Heart disease. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 9th ed. Philadelphia, Pa:Saunders Elsevier; 2011:chap 65.

Reviewed By

Review Date: 12/05/2011

Kurt R. Schumacher, MD, Pediatric Cardiology, University of Michigan Congenital Heart Center, Ann Arbor, MI. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

Answer 3

Normal Anatomy

The heart pumps blood throughout the body. It is located in the thorax.

Indications

The type and timing of surgical repair depends on the child's condition and the type and severity of heart defects.

In general, symptoms that indicate that surgery is needed are:

• difficulty breathing because the lungs are wet, congested, or fluid-filled (congestive heart failure)
• problems with heart rate or rhythm (arrhythmias)
• excessive work load on heart that interferes with breathing, feeding, or sleeping

Procedure

An incision may be made through the breastbone (sternum) and between the lungs (mediastinum) while the child is deep asleep and pain-free (under general anesthesia). For some heart defect repairs, the incision is made on the side of the chest, between the ribs (thoracotomy) instead of through the breastbone. Heart-lung bypass may be needed. Tubes are used to re-route the blood through a special pump that adds oxygen to the blood and keeps it warm and moving through the rest of the body while the repair is being done.

Aftercare

Most children need to stay in the Intensive Care Unit for 3 to 7 days and stay in the hospital for 5 to 14 days. By the time the child is transferred out of the intensive care unit, most of the tubes and wires have been removed and he is encouraged to resume many of his daily activities. At the time of discharge, the parents are instructed on activity, how to care for the incision and how to give medications their child may need to take such as Digoxin, Lasix, Aldactone and Coumadin. The child needs at least several more weeks at home to recover.

Reviewed By

Review Date: 12/05/2011

Kurt R. Schumacher, MD, Pediatric Cardiology, University of Michigan Congenital Heart Center, Ann Arbor, MI. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.