This is a congenital heart defect (means present at birth) in which an opening between the 2 major heart blood vessels happens. These blood vessels lead from the heart. This condition is known as Patent ductus arteriosus (PDA). Commonly, this condition occurs during pregnancy. Ductus arteriosus is a part of the baby’s blood flow system in the womb. In normal circumstances, it closes in a short period after birth. In case it remains open, this disease happens.
While some people experience a small PDA, which does not require treatment, others may have a large PDA which usually leads to reduced oxygen in the blood. If it is not treated, it weakens the heart muscle, which can cause heart failure and other complications.
Common treatment methods for PDA include regular checkups, medications, and surgery.
Symptoms
Mild forms of PDA usually do not provoke any symptoms. The severity of the symptoms depends on the opening size and the patient’s age. In any case, a large form of this condition can cause heart failure even after birth. Check some symptoms of a large PDA form found in infancy or childhood:
- Easy tiring
- Fast heart rate
- Persistent breathing or breathing problems
- Poor eating (which can lead to delayed growth and development)
If you notice that your child experiences shortness of breath or any of the symptoms listed above, immediately contact your healthcare professional.
Causes
Experts do not understand fully the causes of congenital heart defects. However, the heart develops and starts beating during the first 6 weeks of pregnancy. In addition, during this period the major blood vessels also start to grow from and to the heart. Usually, heart defects occur when the heart and its major blood vessels start developing.
However, a temporary opening known as ductus arteriosus is needed for a baby’s blood flow before birth. After birth, this opening of these 2 major blood vessels (aorta and pulmonary artery) closes. Additionally, during pregnancy, the baby gets oxygen from the mother’s blood.
Normally, the ductus arteriosus closes within 2-3 days after birth. However, in some infants, these blood vessels remain open. Over time, it causes too much blood flow to the lungs and heart. As a result, hypertension may occur and the heart can become larger and weak.
Risk Factors
Check below some factors that could increase the baby’s risk of this congenital heart defect:
- Premature birth – Usually, PDA appears in children who were born too early compared to those born at full term.
- Family history and other genetic conditions – A family history of heart problems and children who were born with an additional 21st chromosome (Down syndrome) are more prone to develop this heart defect.
- German measles during pregnancy – In case the mother has German measles (rubella) during pregnancy it may provoke heart development problems in the baby. So, it is advised to perform tests before pregnancy to make sure you do not have rubella. However, if tests confirm German measles, you may need a vaccine.
- Babies born at high altitudes – Those who were born above 8,200 feet (2,499 meters) are at higher risk of getting PDA.
- Women – PDA is identified in girls as twice as common than in boys.
What Are The Possible Complications of PDA?
While a small form of this condition does not cause any symptoms or complications a large form can lead to the following health problems. Examples include:
- High blood pressure in the lungs (also known as pulmonary hypertension) – It happens due to irregular blood flow in the heart and lungs. Over time, elevated pressure can damage the small blood vessels in the lungs, which can lead to Eisenmenger syndrome (dangerous and permanent lung damage).
- Heart failure – This is a life-threatening complication. Poor weight gain, gasping breaths, and fast breathing are the most common symptoms.
- Heart infection (endocarditis) – PDA can elevate your risk of developing this heart infection. It is not advised to ignore this complication because it may lead to death.
PDA and Pregnancy
It is possible to have a healthy and successful pregnancy with a small patent ductus arteriosus. In any case, a large PDA form or complications including heart failure, arrhythmia, or lung damage can elevate the risk of life-threatening complications during pregnancy. It is advised to consult with your doctor if you administer heart medications because they increase the risk of complications and can provoke serious problems in the developing baby. In such cases, doctors may lower the dose or even change the medicine before pregnancy.
Prevention
However, it is not possible to prevent this condition but the only way to reduce the risk of PDA is to have a healthy pregnancy. Check below some tips that could help you:
- Quit smoking, manage or reduce stress, and stop using birth control medicines before birth. It is also advised to consult with your doctor about all medications you are administering including prescription ones.
- Adopt a healthy diet including folic acid.
- Regularly exercise
- Avoid alcoholic beverages and secondhand smoke
- It is also recommended to get or update your vaccinations before pregnancy (such as the rubella vaccine)
- Keep control of blood sugar levels
Diagnosis
To diagnose this condition, doctors will ask questions about the symptoms and medical history. They can also listen to your heart during a physical examination with a stethoscope to check for heart sound abnormalities. To confirm the disease they usually perform the following tests. Examples include:
- Echocardiogram – This is a test that helps doctors get images of the beating heart. It uses sound waves and can also show how blood flows through the heart, heart valves, and other heart’s blood vessels. Sometimes, this test is enough to confirm PDA.
- Chest X-ray – It shows the condition of the lungs and heart.
- Electrocardiogram – This is a quick test that records the electrical impulses of the heart. It helps to determine the heart rate.
- Cardiac catheterization – Commonly, this test is not used to diagnose PDA but physicians may perform it to find the best treatment option for you.
Treatment
Usually, the treatment prescribed by the doctors is different among people. It depends on the severity of the condition, its type, and the person’s age. People with a small PDA do not need treatment but regular checkups are recommended. In addition, regular appointments with the doctors are advised also if a premature baby has a PDA to make sure it closes. Check below some treatment options usually prescribed by doctors:
Medicines
Physicians usually prescribe NSAIDs (nonsteroidal anti-inflammatory drugs) to premature babies in the treatment of patent ductus arteriosus. This group of medicines can help to block chemicals that prevent a PDA from closing. However, these medications cannot treat completely the condition.
Furthermore, physicians recommended in the past for people born with this heart defect to administer antibiotics before each dental procedure or surgery to prevent heart infections. Nowadays, antibiotics are no longer advised for patients with PDA.
Surgery and Other Treatment Options
The following PDA treatment methods are used to close completely an open ductus arteriosus. For example:
- Using a catheter (a thin tube) – In such cases, along with this thin tube, a plug or coil is used to close the opening. This procedure helps to allow surgery that repairs blood vessels without open-heart surgery.
However, small babies cannot receive this procedure. Therefore, if the condition does not cause any health problems, a catheter can be performed when the baby is older. - Open-heart surgery – This procedure is also known as surgical closure. It involves a small cut between ribs which allows doctors access to the child’s heart. Doctors recommend this treatment method when medications cannot help and the patient experiences a large form of PDA or it provokes complications.
In any case, there are some people born with PDA who require checkups for their entire life even if they received a treatment that closes the opening. In an ideal case, you should seek medical attention from a specialist trained to treat adults with heart problems before birth. Such healthcare providers are known as congenital cardiologists.
Frequently Asked Questions
Is considered patent ductus arteriosus a medical emergency?
Immediately, contact a healthcare professional if you notice that your child experiences shortness of breath.
What happens if PDA is left untreated?
You should not ignore this health problem because it may lead to some unpleasant outcomes. Examples include endocarditis (inflammation and infection of the heart’s lining), pulmonary edema (excess fluid in the lungs), heart failure, and others. Consult with your healthcare professional for more details.
What is the most effective medication for people with PDA?
Healthcare professionals usually prescribe intravenously (IV) Indomethacin or Ibuprofen to treat this condition in neonates and premature infants. However, never give your child this medication without a doctor’s recommendation. If you have any other questions, ask your healthcare provider.
