Ductus Arteriosus is a small tubular connection between the pulmonary artery and the aorta that diverts the entire output of blood from the right ventricle to the aorta. It is present in all babies growing in the uterus. In a normal situation, the ductus closes within hours of birth. Failure of the ductus to close gives rise to the condition called Patent Ductus Arteriosus (PDA).
The incidence of isolated PDA in a full-term baby is 5-8% of all congenital heart diseases. On the other hand, the incidence is very high in preterm deliveries approaching almost 50% in very preterm babies.
Patent Ductus Arteriosus (PDA): Causes
Patent Ductus Arteriosus affects girls more often than it affects boys. This condition is more common in premature infants and those with neonatal respiratory distress syndrome. The causes of PDA are:
A syndromic association such as Rubella - Mothers suffering from Rubella (German measles) during pregnancy
HLHS, TGV & Pulmonary Stenosis ( in such conditions this is essential for survival)- Babies with congenital heart problems such as Hypoplastic Left Heart Syndrome (HLHS), Transposition of the Great Vessels (TGV), and Pulmonary Stenosis
Patent Ductus Arteriosus (PDA): Signs & Symptoms
PDA leads to shunting of blood from the aorta into the pulmonary artery leading to increased blood flow into the lungs. In term babies, this is usually well-tolerated; however, in the presence of a broad duct, symptoms of heart failure like irritability, sweating during feeds, and increased respiratory rates are seen.
A small PDA may not show any symptoms. But some infants may exhibit certain signs including:
Poor feeding habits Rapid pulse
Shortness of breath
Sweating while being fed
Getting tired very easily
Patent Ductus Arteriosus (PDA): Expertise
Max Institute of Paediatrics is one of the finest childcare centres in India ‘Where Children Come First’. Our state-of-the-art Neonatal Intensive Care Units (NICU) and Paediatric Intensive Care Unit (PICU) provides complete care and support to critically ill children. We have a team of experienced paediatricians and paediatric surgeons who specialize in paediatric surgery, paediatric orthopaedics, paediatric endocrinology, paediatric cardiology & cardiac surgery, paediatric pulmonology, paediatric nephrology, paediatric oncology, paediatric haematology, developmental specialist, and adolescent paediatric Our General Paediatrics experts specialise in treating a range of newborn problems, issues, and conditions, including Patent Ductus Arteriosus.
In cases for premature babies, Patent Ductus Arteriosus (PDA) closes within the first 2 years of life, but in the case of a fully mature baby, treatment is required. Max Institute of Pediatrics, is equipped to treat this condition through medication, and in cases where medication doesn’t provide desired results, a Catheter procedure is carried out.
Patent Ductus Arteriosus (PDA): Approach
In PDA, all but the smallest ducts need to be closed. This is to prevent heart failure and another dangerous and rare complication from an infection - Infective Endarteritis.
At Max Institute of Paediatrics, small ducts that cannot be diagnosed with clinical exams can be detected via Colour Doppler Echocardiogram. Also, almost all PDAs are closed by a non-surgical procedure called PDA Device Closure.
In certain less common conditions such as pulmonary atresia, hlhs PDA may need to remain open for survival, and in such cases, PDA may need stenting which is commonly done at Max hospital, Saket
In some anatomical variants of the duct where a PDA Device Closure may not be possible, surgical ligation will be needed. Surgery for ligating PDA is a very simple, closed heart procedure as the communication is outside the heart.
But no matter whichever way the PDA is closed, it is a cure with no long-term sequelae and a normal life span. Once all physical exams and diagnostic tests are completed, the treatment can begin.
Patent Ductus Arteriosus (PDA): Procedure
PDA in premature babies closes within the first two years of life. But if the patient is a full-term child, a PDA rarely closes on its own after the first few weeks. In such cases, it requires treatment.
At Max Institute of Paediatrics, treatment options for Patent Ductus Arteriosus include:
Medications: In preterm babies, PDA often causes a problem and may contribute to respiratory distress, or another life-threatening complication called Necrotising Enterocolitis. In such situations, anti-inflammatory drugs may be given to promote the closure of the duct. In rare cases, PDA device closure or surgery may be needed to ligate the duct. These work very well for some newborns, with few side effects. The earlier treatment is given, the more likely it is to succeed.A medical procedure is used if medications don’t work well or can’t be used.
Catheter Procedure: In this treatment, a thin, hollow tube is placed into a blood vessel. The doctor passes a small metal coil or other blocking devices through the catheter to the site of the PDA. This process blocks the blood flow through the vessel. The coils or devices can help the baby avoid surgery.
PDA Occlusion: If uncorrected, moderate to large PDAs can lead to a condition called Eisenmenger Syndrome where the hardening of pulmonary arteries causes a reversal in the initial direction of blood flow. This usually occurs by the age of 20 - 30 years and signals inoperability. All moderate to large PDAs, therefore, need to be closed - usually by means of a PDA occluding device, inserted through a small puncture from the groin.