Patent ductus arteriosus (PDA)

Overview

Patent ductus arteriosus (PDA) is a persistent opening between the two major blood vessels leading from the heart. The heart problem is present from birth. That means it is a congenital heart defect.

An opening called the ductus arteriosus is part of a baby's blood flow system in the womb. It usually closes shortly after birth. If it remains open, it's called a patent ductus arteriosus.

A small patent ductus arteriosus often doesn't cause problems and might never need treatment. However, a large, untreated patent ductus arteriosus can let oxygen-poor blood move the wrong way. This can weaken the heart muscle, causing heart failure and other complications.

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

Symptoms

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.
• Persistent fast breathing or breathlessness.
• Easy tiring.
• Rapid heart rate.

When to see a doctor

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.

Causes

The exact causes of congenital heart defects are unclear. During the first six weeks of pregnancy, a 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 heart defects may begin to develop.

Before birth, a temporary opening called the ductus arteriosus is between the two main blood vessels leaving a baby's heart. Those vessels are the aorta and the pulmonary artery. The opening is necessary 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 persistent 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

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 problems present at birth may increase the risk for a PDA. Babies born with an extra 21st chromosome, a condition called Down syndrome, also are more likely to have this condition.
• German measles during pregnancy. Having German measles, also called rubella, during pregnancy can cause problems in a baby's heart development. A blood test done before pregnancy can determine 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 a PDA than babies born at lower altitudes.
• Being female. Patent ductus arteriosus is twice as common in girls.

Complications

A small patent ductus arteriosus might not cause complications. Larger, untreated defects 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 rises in the pulmonary artery. Over time, the increased pressure damages the smaller blood vessels in the lungs. A life-threatening and permanent 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. A patent ductus arteriosus can increase the risk of infection of the heart tissue. This infection is called endocarditis. It can be life-threatening.

Causes

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 complications such as heart failure, irregular heartbeats or lung damage increases the risk of serious complications during pregnancy.

Before becoming pregnant, talk to your health care provider about possible pregnancy risks and complications. Some heart medicines can cause serious problems for a developing baby. Your health care provider may stop or change your medicines before you become pregnant.

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

Prevention

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:

• Seek early prenatal care, even before you're pregnant. Quitting smoking, reducing stress, stopping birth control — these are all things to talk to your health care provider about before you get pregnant. Tell your health care provider about all the medicines you take, including those bought without a prescription.
• Eat a healthy diet. Include a vitamin supplement that contains folic acid. Taking 400 micrograms of folic acid daily before and during pregnancy has been shown to reduce brain and spinal cord problems in the baby. It also may help reduce the risk of heart problems.
• Exercise regularly. Work with your health care provider to develop an exercise plan that's right for you.
• Don't drink 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 problems before birth.

Diagnosis

The health care provider does a physical exam and asks questions about your medical history. The care provider may hear a heart sound called a murmur while listening to the heart with a stethoscope.

Tests that may be done to diagnose patent ductus arteriosus include:

• Echocardiogram. This test uses sound waves to create pictures of the beating heart. It shows how blood flows through the heart, heart valves and nearby blood vessels. The test tells your health care provider how well your heart is pumping blood. It can show a patent ductus arteriosus. An echocardiogram also can detect higher pressures in the lung arteries.
• Chest X-ray. This test shows the condition of the heart and lungs.
• Electrocardiogram. This quick and simple test records the electrical signals that make up the heartbeat. It shows how fast or how slowly the heart is beating.
• Cardiac catheterization. This test isn't usually needed to diagnose a PDA. But it might be done if a PDA occurs with other heart problems. A long, thin flexible tube (catheter) is inserted in a blood vessel, usually in the groin or wrist, and guided to the heart. During this test, the health care provider may be able to do treatments to close the patent ductus arteriosus.

Treatment

Treatments for a patent ductus arteriosus depend on the age of the person being treated. Some people with small PDAs that aren't causing problems only need regular health checkups to watch for complications. If a premature baby has a PDA, the health care provider does regular checkups to make sure it closes.

Medications

Medicines called nonsteroidal anti-inflammatory drugs (NSAIDs) may be given to premature babies to treat a PDA. These medicines block certain body chemicals that keep a PDA open. However, these medicines won't close a PDA in full-term babies, children or adults.

In the past, health care providers told people born with a PDA to take antibiotics before dental work and certain surgical procedures to prevent certain heart infections. This is no longer recommended for most people with a patent ductus arteriosus. Ask your health care provider if preventive antibiotics are necessary. They might be recommended after certain heart procedures.

Surgery or other procedures

Advanced 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 allows a repair to be done without open-heart surgery.

  During a catheter procedure, the health care provider inserts a thin tube into a blood vessel in the groin and guides it to the heart. A plug or coil passes through the catheter. The plug or coil closes the ductus arteriosus. The treatment doesn't usually require an overnight hospital stay.

  Premature babies are too small for catheter treatments. If the PDA isn't causing problems, 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. Heart surgery may be needed if medicine doesn't work or the PDA is large or causing complications.

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

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

Lifestyle and home remedies

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 problems. Quitting is the best way to reduce the risk. If you need help quitting, talk to your provider.
• 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 restrictions. Some people born with a heart problem may need to limit exercise or sports activities. Ask your care provider which sports and types of exercise are safe for you or your child.
• Manage stress. Find ways to help reduce emotional stress. Getting more exercise, practicing mindfulness and connecting with others in support groups are some ways to reduce and manage stress. If you have anxiety or depression, talk to your provider about strategies to help.

Preparing for an appointment

A large patent ductus arteriosus or one that's causing serious health problems may be diagnosed immediately at birth. But some smaller ones might not be noticed until later in life. If you have a PDA, you may be referred to a health care provider trained in heart problems present at birth. This type of provider is called a congenital cardiologist. A provider 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 pre-appointment restrictions. When you make the appointment, ask if there's anything you need to do in advance, such as avoid eating or drinking before certain tests.
• Write down the symptoms, including any that might seem unrelated to patent ductus arteriosus or another heart problem.
• Write down important personal information, including family history of heart problems.
• Bring copies of past medical records, including reports from previous surgeries or imaging tests.
• List medications, vitamins or 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 health care provider.

For patent ductus arteriosus, questions to ask include:

• Is the PDA causing problems?
• What tests are necessary?
• Will I or my child need surgery?
• What are the alternatives to the primary approach that you're suggesting?
• Should I or my child see a provider specializing in congenital heart defects?
• Is this condition passed down through families? If I have another child, how likely is he or she to have a PDA? Do my family members need to be screened?
• Do I need to restrict my or my child's activities?
• Are there brochures or other printed material I can have? What websites do you recommend?

Don't hesitate to ask other questions, as well.

What to expect from your doctor

The doctor is likely to ask you a number of questions, such as:

• When did you notice your or your child's symptoms?
• Have the symptoms been continuous or occasional?
• How severe are the symptoms?
• What, if anything, seems to improve the symptoms?
• What, if anything, seems to worsen the symptoms?
• What medications have you or your child taken to treat the condition? What surgeries have you or your child had?