Patent Ductus Arteriosus (PDA)
While every parent wants their children to be born healthy, some infants have a range of disorders present at the time of birth. Patent Ductus Arteriosus or PDA is one such condition that manifests in children when they are born. Here is all you need to know about Patent Ductus Arteriosus (PDA).
What is PDA?
PDA is the opening between the two major blood vessels leaving from the human heart. The ductus arteriosus is an essential part of a child’s circulatory system before birth. This vessel closes a few days post the birth of the child, as the same functionality is now performed by the infant’s lungs. However, if the ductus arteriosus stays open after birth, it is called a patent ductus arteriosus (PDA).
The physiological impact and clinical significance of the PDA depend largely on its size and the underlying cardiovascular status of the patient. The PDA may be “silent”, small, moderate, or large. Regardless of the size, complications may arise, and it is important for both pediatric and adult cardiologists to have an understanding of the pathophysiology, clinical implications, and management of PDA.
EPIDEMIOLOGY: Patent Ductus Arteriosus is a rare condition having fewer than 200,000 cases per year. It occurs in newborns for 1 in 2,000 births and makes up 5%-10% of all congenital heart diseases. Most commonly in premature babies ranging from 20%-60%. The mortality rate of Patent Ductus Arteriosus is 20% by age 20 years, 42% by age 45 years, and 60% by age 60 years.
SYMPTOMS: Symptoms of a PDA (Patent Ductus Arteriosus) depend on the size of the ductus and how much blood flow it carries. After birth, if a ductus arteriosus is present, blood will flow from the aorta into the pulmonary artery.The extra blood flow into the lungs can overload the lungs and put a lot of strain on the heart to pump the blood. Some babies may need more support from a ventilator and have symptoms of congestive heart failure.
A large PDA in a newborn will show symptoms of:
Fast breathing
A hard time breathing
Respiratory Infections
Getting tired easier
Not being able to thrive
not wanting to eat
poor growth
Fast heart beat
A small PDA may not show symptoms
Doctor will have to do further evaluation by listening to the infant’s heart murmur
The turbulent flow of blood through the PDA puts a person at a higher risk for a serious infection, known as endocarditis.
An infection of the heart’s inner lining, usually involving the heart valves.
ASSOCIATIONS WITH OTHER SYMPTOMS: Long term Patent Ductus Arteriosus can lead to another disease called Eisenmenger syndrome, which is an irreversible type of pulmonary hypertension or heart failure. The Eisenmenger syndrome is a long-term complication of an unrepaired heart effect caused by Patent Ductus Arteriosus. This syndrome causes blood to circulate abnormally in your heart and lungs. The Eisenmenger syndrome can lead to long-term effects such as…
Low oxygen levels in your blood
High red blood cell count
Heart failure
Coughing up blood
Stroke
Kidney Problems
While, Eisenmenger syndrome is a life-threatening condition. Some people diagnosed with the syndrome have survived into their 50s,60s,or even longer.
TREATMENT: Medication is used for premature babies who are too young for alternative methods. Some forms of medication include NSAIDS (Non sterile anti-inflammatory drugs) and Ibuprofen, infant advil and motrin. These medications work to constrict muscles around the opening to close it. They also block hormone-like chemicals that keep the PDA open. Surgery closure of the PDA is used in full term babies, children, and adults this process includes using stitches or clips, and risks are paralysed diaphragm, bleeding, and infection. Doctors also use catheters to treat full-term babies, children, and adults. In this process, a thin tube used to insert a plug or coil to close the opening. Since premature babies cannot receive this procedure, a doctor might recommend it for when they are older.
PROGNOSIS/COMPLICATIONS: A patient who has PDA is recommended to have VAT surgical ligation, where the PDA is closed with stitches or clips. Infants who present with symptoms are recommended to have the surgery at about 6 months of age. Infants who do not present with any symptoms may have their surgery delayed until about 6-12 months of age (“Pediatric Patent Ductus Arteriosus (PDA) – Conditions and Treatments | Children’s National Hospital”). Because of how young patients are with PDA, the condition can easily be treated early enough to prevent any serious damage.
Complications:
Difficulty breathing due to higher blood pressure in the lungs.
Long-term lung damage (rare)