Patent Ductus Arteriosus (PDA) - Congenital Heart Disease Surgery
CONGENITAL PATENT DUCTUS ARTERIOSUS (PDA)
While still in the womb, a baby does not require their lungs to supply oxygen because they get oxygen from their mother. Since a baby's lungs do not supply oxygen, there is no need for the heart to pump blood to the lungs. The Ductus Arteriosus is a blood vessel that is available in all babies while still in the womb, and it lets blood to bypass the lungs.
When the baby is delivered and the umbilical cord is cut, their lungs need to provide oxygen to their body. Their lungs expand and the blood vessels calms down to accept more blood flow, and the ductus arteriosus normally closes within the first hours of life. Sometimes, the ductus arteriosus does not close by itself. This condition is known as a patent ("open") ductus arteriosus. While this condition is seen more in premature babies, it may also show in full-term infants.
Signs and Symptoms
The symptoms of a patent ductus arteriosus relies on the mass of the ductus and how much blood flow it carries. After birth, if a ductus arteriosus is present, blood will flow from the aorta (the major artery in the body) into the pulmonary artery. This further blood flow into the lungs can overload the lungs and put more burden on the heart to pump this extra blood. Some babies may need more help from a ventilator and have signs of congestive heart failure.
A newborn with a patent ductus arteriosus may experience:
• Fast breathing
• A hard time breathing
• More respiratory infections
• Tire more easily
• Poor growth
However, if the patent ductus arteriosus is not big, it may cause no symptoms and the doctor may not find it until they do further assessment of a heart murmur.
Even if there are no symptoms, the unstable flow of blood through the patent ductus arteriosus puts a person at a greater risk for a serious infection, known as endocarditis.
Diagnosis of Patent Ductus Arteriosus
Because of turbulent blood flow, a patent ductus arteriosus produces a distinct sounding heart murmur that is heard on physical exam.
The murmur, together with symptoms of heart failure in a premature infant, more often cause the diagnosis of patent ductus arteriosus. A chest X-ray will show an enlarged heart and reason of a large amount of blood flow to the lungs. An echocardiogram is carried out to confirm the diagnosis. Your doctor can see the size of the ductus arteriosus and also find out if the heart chambers have become enlarged as a result of the extra blood flow.
In older children, though, their chest X-ray is generally normal. An echocardiogram will display the flow of blood through the patent ductus arteriosus and is normally done to confirm the diagnosis.
Treatment for Patent Ductus Arteriosus
In a newborn, the patent ductus arteriosus still has the possibility to close on its own. Your doctor may give more time for the patent ductus arteriosus to close on its own if their heart failure is under control. If a newborn’s symptoms are very serious or it is unlikely to close on its own, clinical or surgical treatment is needed.
Medicines work well for newborns. They may receive medicine, such as indomethacin or ibuprofen, to tighten the muscle in the wall of the patent ductus arteriosus and help it close. These drugs may have side effects, so not all babies can receive them.
Closing the patent ductus arteriosus is more of a common option for older infants and children. This includes surgery or closing the PDA in the cardiac catheterization laboratory with the aid of a device or coil.
During the cardiac catheterization procedure:
• Your child is either sedated or placed under normal anesthesia, depending on how old they are.
• Catheters are inserted into blood vessels in the groin and threaded up the aorta, preventing close of the ductus arteriosus.
• A picture (called an angiogram) is taken to show the shape and size of the ductus arteriosus.
• If the ductus is small, your doctor may place a coil in the vessel. For larger openings, the doctor can use a plug-shaped tool to block the vessel.
A child, of any age, can have surgery to close the patent ductus arteriosus. Surgical proocedure is the best option for a child who have a very large patent ductus arteriosus or other irregular anatomy.
If your child has surgery:
• A small incision is made amid the ribs on the left side.
• The ductus arteriosus is coupled and cut.
The risk of complications with any of these treatments is minimal, determined mostly by how sick the child is before the treatment.
Patent Ductus Arteriosus: Ever a GOOD Thing?
Yes. Some babies may have a heart defect that needs the patent ductus arteriosus to remain open for them to survive.
In certain heart defects, such as pulmonary atresia (an underdeveloped or blocked pulmonary valve), the patent ductus arteriosus provides the only adequate source of blood flow to the lungs so that oxygen can be sent to the blood. In these patients, the ductus arteriosus providess blood to the lungs from the aorta.
In other anomalies, such as underdeveloped or seriously narrowed aorta (like that seen in hypoplastic left heart syndrome), the patent ductus arteriosus is vital to allow adequate blood flow to the body. The ductus arteriosus provides blood to the body from the pulmonary artery.
Medication is given, and the baby is observed closely in the intensive care unit. Keeping the patent ductus arteriosus open using this medicine gives time for the newborn to become stable until other treatments, regularly surgery, are done.
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