Last updated on January 11, 2022
Content By: Dr. Nikita Toshi BDS, Assistant Manager (Medical Review), Dr. Ritu Budania MBBS, MD (Pharmacology) Head, Medical Affairs
Last updated on January 11, 2022
Patent Ductus Arteriosus is a type of condition where the communication between two main blood vessels leading from the heart does not close after birth. The ductus arteriosus or the opening is the normal part of a child’s circulatory system when the child is inside the womb, which closes down right after birth. But if it remains open, the condition is termed patent ductus arteriosus.
On certain occasions, patent ductus arteriosus does not require any treatment, but if it’s left untreated, it will cause poorly oxygenated blood to flow in the wrong direction. Untreated, large patent ductus arteriosus can also cause heart failure, weaken the heart muscles and cause various other complications. Having a thorough understanding of patent ductus arteriosus symptoms can facilitate an early diagnosis and more effective treatment. There are several treatments for ductus arteriosus closure available in India and you must consult a doctor regarding it.
Read on to learn more about patent ductus arteriosus symptoms, causes, diagnosis and treatment options that can help improve the outlook from this comprehensive guide.
Patent Ductus Arteriosus is a type of condition where the communication between two main blood vessels leading from the heart does not close after birth. The ductus arteriosus or the opening is the normal part of a child’s circulatory system when the child is inside the womb, which closes down right after birth. But if it remains open, the condition is termed patent ductus arteriosus.
On certain occasions, patent ductus arteriosus does not require any treatment, but if it’s left untreated, it will cause poorly oxygenated blood to flow in the wrong direction. Untreated, large patent ductus arteriosus can also cause heart failure, weaken the heart muscles and cause various other complications. Having a thorough understanding of patent ductus arteriosus symptoms can facilitate an early diagnosis and more effective treatment. There are several treatments for ductus arteriosus closure available in India and you must consult a doctor regarding it.
Read on to learn more about patent ductus arteriosus symptoms, causes, diagnosis and treatment options that can help improve the outlook from this comprehensive guide.
Written by
BDS, Assistant Manager (Medical Review)
Reviewed by
MBBS, MD (Pharmacology) Head, Medical Affairs
It is not necessary for the fetus’s blood to reach the lungs to be oxygenated prior to birth. The ductus arteriosus is a communication between the aorta (heart’s major blood vessel) and pulmonary artery (a blood vessel that carries oxygen-deficient blood from the heart to lungs) that enables the blood to skip the circulation to the lungs. But when the child is born, the blood needs oxygen from the lungs and the ductus arteriosus has to be closed. But if it remains open even after a few days of birth, it is called patent ductus arteriosus (PDA).
In the majority of the babies that have a normal heart, there will be no sign of symptoms for patent ductus arteriosus because the PDA will shrink and then close on its own and no kind of treatment will be needed. But if it stays open for a long time, it will allow the oxygen-deficient blood to flow in the wrong direction.
If the PDA is large enough, it will surely cause some problems and you need proper patent ductus arteriosus treatment to get relief from it. A small PDA that doesn’t close may also seal by itself when the child is a year old.
PDA is a condition usually found in preterm infants, especially in 70% of the infants who are less than 28 weeks and 80% in 24 to 25 weeks of gestation. This particular condition takes place in 15% to 37% of infants who weigh less than 1750 grams at birth. These figures are pretty high when compared with the incidences of 2/1000 in terms of newborns. Apart from India, the presence of symptoms for patent ductus arteriosus was also found in infants globally. In the United States, about 3000 babies are diagnosed with is this condition every year.
The natural closure of the ductus arteriosus takes place 2 or 3 days after birth. If it remains open even after that, it is referred to as patent ductus arteriosus. This condition occurs more in babies who are born way too early(premature) than the babies who are born in full term. Patent ductus arteriosus causes problems when the opening is large in size and is not treated properly.
There are two types of patent ductus arteriosus namely, small PDA and large PDA. When a child has a large PDA, the extra blood flow becomes too much for the child’s heart to handle. This makes it a lot harder for them to breathe. This is mainly because PDA can increase the heart’s work and the baby might have heart failure. When it comes to small PDA, the risk of developing heart failure is not that high. But if there is enough blood, it causes abnormal noises or patent ductus arteriosus murmur and the PDA should be closed.
Doctors can easily hear the patent ductus arteriosus murmur with the help of a stethoscope on a baby who has PDA. These types of symptoms for patent ductus arteriosus can also occur later in life due to the increase of blood flow into the lungs during the later years. The patent ductus arteriosus symptoms include pulmonary hypertension [high blood pressure within the blood vessels of the lungs], heart failure and heart rhythm abnormalities. Pulmonary hypertension treatment involves taking medications, or in some cases, undergoing surgeries like atrial septostomy or lung transplant.
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When it comes to the signs and symptoms of PDA, you will come across many of them. If you do encounter them in your child, you must immediately consult a doctor. Given below are a few of the patent ductus arteriosus symptoms:
Blue discolouration of the skin: The patent ductus arteriosus in newborns can turn their skin colour to blue as they are not getting enough oxygen.
Excessive sleepiness: PDA can cause excessive sleepiness in infants, which means they will feel sleepy the whole day.
Palpitations: This particular condition can also trigger palpitation in a newborn where the heart starts to beat faster.
Poor growth: The patent ductus arteriosus in newborns also affects the growth heavily, which occurs due to inefficient suckling and poor eating.
Rapid breathing: Rapid or heavy breathing is also one of the signs of PDA, which also takes place in infants.
Excessive sweating with crying or eating: Sweating heavily when eating and crying is something that occurs in babies.
Getting tired easily: An older child with PDA will surely feel very tired even after engaging in a few activities.
When your child is getting tired after eating or playing, not gaining proper weight, becomes breathless when crying or eating, you should consult the doctor. The doctor will check the type of issue your child is experiencing. Whether it’s a patent ductus arteriosus surgery or PDA medication the doctor will make sure to offer the best treatment plan that can help reduce symptoms for patent ductus arteriosus in your child. You need to follow all the instructions that the doctor provides without any delay.
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The causes of patent ductus arteriosus are unknown; it usually occurs during heart development. However, genetic factors and premature birth are known to play a role.
Experts are currently not aware of what causes PDA but congenital heart issues like hypoplastic left heart syndrome (a heart defect found at birth that affects normal blood flow through the heart) can cause this condition. Genetics play a massive role here because PDA in newborns can occur due to the genetic disorder, Down Syndrome. Apart from that, babies suffering from Neonatal Respiratory Distress Syndrome (a breathing disorder that occurs in infants whose lungs are not yet fully formed) can also develop PDA.
Premature birth is one of the main causes of PDA. If you are child was born prematurely, there is a high chance that he or she might have this particular condition. It will be a good idea to get your baby checked by a specialist and make preparations accordingly.
The PDA heart defect comes with numerous risk factors, which includes:
Rubella infection in the mother during pregnancy: If you have contracted Rubella (a viral infection) or German Measles during the time of your pregnancy, the risk of PDA heart defect in your baby will more likely increase. Rubella crosses the placenta and then invades the circulatory system of the baby, which damages the organs, blood vessels and also heart.
Gender: PDA is more common in girls. The symptoms for patent ductus arteriosus are found a lot more in females than males.
High altitude births: Babies who are born above 2800 feet or 2499 meters have a high chance of developing PDA when compared with babies who are born in low altitudes.
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When it comes to patent ductus arteriosus diagnosis, there are several tests, which you can opt for. These tests will provide you with information about the type of PDA your baby is suffering from. Read on to learn more about diagnostic tests for patent ductus arteriosus.
Chest X-ray: Chest x-ray is the test that will allow doctors to see the condition of a baby’s lungs and heart. Premature babies might not have the same conditions as full-term babies and have to undergo other tests to confirm the condition.
Echocardiogram: Echocardiogram is the gold standard test, a useful patent ductus arteriosus diagnosis technique that utilizes sound waves to create an image of the baby’s heart. The procedure is completely painless and will enable the doctor to see the heart’s structure and assess the patent ductus arteriosus. By taking a look at the images, the doctor will tell you whether to go for patent ductus arteriosus surgery or medication.
Electrocardiogram: EKG or Electrocardiogram is another method that helps in recording the electrical activity in the heart and will also detect irregular heart rhythms. EKG can also detect enlarged heart in babies.
Cardiac Catheterization: In this procedure, a catheter (thin tube) is inserted into an artery (blood vessel) in the arm or groin. Then, it is navigated through the blood vessel into the aorta (the largest artery) and into the heart. Once the catheter is in the intended place, several tests can be carried out.
Cardiac catheterization is not always necessary for diagnosing PDA. But it gets done to examine all the other congenital heart problems, which are found in echocardiograms or when a catheter procedure is considered for treating this condition.
The first step for patent ductus arteriosus management is to prepare for the diagnosis. You need to be well aware of the pre-appointment restrictions. When you are making an appointment with the doctor, ask whether or not you have to do anything in advance like restrict your and your child’s diet.
Apart from that, write down all the symptoms, which you and your child are experiencing. You must also list down symptoms that seem unrelated to PDA or another heart problem. When making preparations for the diagnosis, you must jot down all the main information, which includes a family history of heart problems.
You must also carry all copies of the past medical records, including past reports of imaging tests or surgeries. Along with that, you must also list down all the medications, supplements and vitamins, which your child takes. Providing all the documents and information to the doctor will not just help you with the patent ductus arteriosus management but will also allow the doctor to conduct the right test on your child.
There are various treatment options available for PDA that can help reduce the patent ductus arteriosus symptoms in your child. These treatments include:
Close monitoring if it’s a premature baby: In a premature baby, the PDA sometimes closes by itself. The doctor will make sure to monitor your child’s heart to check whether or not the blood vessels are closing correctly. For all the full-term babies, adults and children who have small PDA and are not causing any issues, monitoring will be required.
Corrective surgery: You should only opt for PDA surgery when the medications are not working and your child’s condition can become severe or cause some complications. In PDA surgery, the surgeon will make a small cut between the ribs to reach the heart. After that, the surgeon will repair the open ductus with clips and stitches. After the surgery, your child should stay at the hospital for a few days for observation and it will take several weeks for your child to recover completely from the heart surgery. The patent ductus arteriosus in adults can also be treated through proper surgery without any issues.
Catheter procedures: In this procedure, the doctor inserts a catheter into the blood vessel in the arm, groin or neck and guides it to the heart using X-ray or ultrasound imaging. The doctor inserts specialized devices to correct the defect. It is not advisable to carry out catheter procedures in premature babies. But if your child doesn’t have any PDA-related complications, your doctor might suggest you wait until your baby is a bit older for the catheter procedure to fix the PDA. Catheter procedures are ideal for treating patent ductus arteriosus in adults and full-term babies.
Medication: Back in the past, adults, babies and even children who have PDAs were advised by the doctors to take antibiotics right before certain surgical procedures or dental work, to help prevent endocarditis (inflammation of the heart’s inner lining). You can and your baby can take preventive antibiotics for the first 6 months after the catheter procedure when you had a heart infection previously or there are damages after the procedure. Some medicines also help in the closure of small PDAs. Be sure to consult your child’s doctor before giving any medicine to your child.
When you have PDA and also had surgery as a child, you might be in danger of developing complications as an adult. For such reason, you must opt for life-long follow-up care, especially when you had corrective heart surgery. Follow up care are just like periodic checkups. Otherwise, it might also involve regular screening to detect any type of complication. You must discuss your care plan with the doctor and you should follow all their recommendations without fail.
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Most of the PDA cases gets diagnosed and treated right after the birth of the child. It’s pretty unusual for PDA to go unnoticed during adulthood and if it does, this condition will cause many health issues.
If the openings are larger, it will cause quite a lot of complications. Given below are a few of the complications that patent ductus arteriosus might lead to:
High BP in the lungs’ blood vessels: When the large PDA is left untreated, it can damage your child’s lungs and heart and cause high blood pressure in the lungs. In other words, when too much blood is forced into the pulmonary artery, it will lead to high blood pressure, also known as pulmonary hypertension. You must opt for immediate treatment for the large PDA so that you can avoid the increase in the lungs’ blood pressure levels.
Heart failure: A small PDA may not cause any major issues. On the other hand, a large PDA allows poorly oxygenated blood to flow in the wrong direction. This results in the weakening of the heart muscle, which in turn, can lead to heart failure. You must speak with your doctor to receive the correct treatment or medication for the large PDA so that heart failure can be prevented.
Heart infections: If you or your child previously had heart infections, the doctor will prescribe certain medications. These medications are essential, especially if you or your child have undergone a catheter procedure.
Children who have the patent ductus arteriosus have to take precautions so that they can prevent further complications from occurring. Here are some of the preventive measures:
Maintaining good personal and oral hygiene: It’s important to maintain oral and personal hygiene when it comes to preventing PDA complications. You should wipe off the baby’s gums with a soft wet cloth after each feeding and you can begin brushing when the first tooth erupts. This will help in preventing oral decay. Both older children and babies must bathe regularly to stay clean. Older children should brush their teeth in the morning and at night after their dinner.
Restricting certain exercises and physical activities: Children who undergo a PDA treatment or surgery have to limit some of the physical activities or exercises as it can lead to complications. You must speak to the doctor about which type of activities and exercises are safe for your child and prevent those that can cause problems.
There is no way that can surely prevent PDA from occurring in some babies. But in general, for a healthy baby and comfortable pregnancy, some tips can be followed by expecting mothers. These tips are:
Healthy diet: Maintaining a healthy diet while you are pregnant will keep your child safe and prevent PDA.
Seeking early prenatal care, even before you pregnant: Managing stress and quitting smoking are things that you must discuss with the doctor right before you think of getting pregnant.
Exercise regularly: You should work with your doctor to create an exercise plan, which you should follow regularly.
Avoid the use of alcohol, tobacco or drugs: When you are pregnant, don’t consume alcohol or drugs.
Control diabetes and blood pressure: Keep your blood sugar in check and work with your doctor to create a proper plan for it. The most common causes of high blood pressure include smoking, stress, lack of physical activity and being obese. Avoiding these can help keep blood pressure levels under control.
The majority of the women who have PDA can handle pregnancy without any issues. But having large complications or defects like pulmonary hypertension and heart failure can increase the risk of complications during pregnancy. If you have a history of PDA or any other heart-related problem, you must consult your gynaecologist before planning pregnancy.
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Seeking support of friends and family members: When your child is suffering from PDA, you will require the support of your family members and friends to help you through the situation.
Increasing awareness of the condition – what to do, what not to do, building a lifestyle/routine/diet, etc: You must increase the awareness of PDA by educating others about it. You should also maintain a good diet that is packed with heart-healthy foods for your child and make them follow the diet chart for heart patients and proper routine so that they can manage symptoms for patent ductus arteriosus properly. Make sure to seek help from the doctor when needed.
Recording/journaling your baby’s health in every stage of life: When your child has PDA, you must keep a journal or record your baby’s health properly.
Joining a parenting support group where you can talk about your concerns: Joining a community where you can talk about PDA and its concerns will allow you to learn more about the condition and seek comfort from parents facing similar situations.
Preparing for your doctor visits – some of the questions you can ask your doctor and answers you can be prepared for: When you are preparing for the doctor’s visit, you will have many questions in your mind. The doctor can only provide you with a solid answer after learning about the symptoms and running some tests.
PDA or patent ductus arteriosus occurs mostly in premature babies. The condition can become worse if it’s left untreated. Excessive sweating, tiredness, bluish appearance of the skin, palpitations are some of its symptoms. The outlook of the condition looks good when PDA gets detected earlier and is treated with medications.
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Certain birth factors such as genetic factors and high altitude at birth are known to increase the risk of developing patent ductus arteriosus in infants. However, there is no specific reason as to why PDA is a lot more common in females than males.
If PDA is left untreated, that condition can surely become life-threatening as it can cause heart failure, high blood pressure and even prove fatal.
A patient who has PDA will experience symptoms like tiredness, pounding of the heart, rapid heart rate and their skin might start turning blue.
In short, yes, when PDA gets diagnosed early, it becomes less risky because the patient receives proper medication and treatment for it.
With proper treatment and medication, a child can surely survive PDA and lead a normal life.
Surgeries, treatments and medications can help in managing the condition better. But sometimes, PDA can shrink on its own and disappear completely without any treatment.
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