Patent Ductus Arteriosus Ligation

What is PDA?

Patent ductus arteriosus (PDA) is a heart defect found in the days or weeks after birth. The ductus arteriosus is a normal part of fetal blood circulation before a baby is born. It’s an extra blood vessel that connects 2 arteries: the pulmonary artery and the aorta. The pulmonary artery carries blood from the heart to the lungs. The aorta carries blood from the heart to the body. Before birth, the ductus arteriosus lets blood go around (bypass) the lungs. This is because the baby gets oxygen from the mother.  All babies are born with this opening between the aorta and the pulmonary artery. But it often closes on its own shortly after birth, once the baby breathes on its own. If it stays open (patent), it is called patent ductus arteriosus. With PDA, extra blood flows to the lungs. If the PDA is large, too much blood goes to the lungs. The blood vessels and the lungs have to work much harder to handle the extra blood. This can lead to fluid buildup in the lungs. The baby can have a harder time breathing and feeding.

‍

What are the symptoms of PDA?

The size of the opening between the aorta and the pulmonary artery will affect symptoms. If your baby has a small opening, he or she may not have symptoms. If your baby has a larger opening, he or she may have symptoms. These are the most common symptoms of PDA:  Skin turns a blue color from not getting enough oxygen (cyanosis)  Very tired  Fast or hard breathing  Trouble feeding, or tiredness while feeding  Infections  Poor weight gain  In older children, trouble doing activities  The symptoms of PDA can seem like other health conditions. Have your child see his or her healthcare provider for a diagnosis.

‍

What other approaches can be used to treat patients with PDA?

1. Medicines Your baby may need medicines help the heart work better. In premature infants, the medicine indomethacin may help close the PDA. Indomethacin stimulates the muscles inside the PDA to tighten. This closes the connection. Some babies may need medicine to help the heart and lungs work better. Sometimes a baby may need medicine such as diuretics (water pills). Diuretics help the kidneys remove extra fluid from the body. This may be needed when the heart is not working well. Or it may be needed if the blood vessels in the lungs have to make room for more blood flow, as with a PDA.  2. Nutrition Most infants with PDA eat and grow normally. Some premature infants or those infants with large PDAs may get tired when feeding. They may not be able to eat enough to gain weight. Nutrition choices include:   -High-calorie supplements. Special nutritional supplements may be added to formula or pumped breastmilk to increase the number of calories. Your baby can drink less and still have enough calories to grow correctly. -Supplemental tube feedings. Supplemental feedings are given through a small, flexible tube. The tube passes through the nose, down esophagus, and into the stomach. The feedings can either be added to or take the place of bottle-feedings. Infants who can drink part of their bottles, but not all, may be fed the rest through the feeding tube. Babies who are too tired to bottle-feed may get all of their formula or breastmilk through the feeding tube.  3. Therapeutic cardiac catheterization  Your doctor will insert a thin, flexible tube (catheter) into a blood vessel in the groin. He or she will guide it through the large blood vessel in the groin to the area of the PDA. The catheter will be placed in the PDA. Dye may be injected at this time to help the provider put the catheter in the right place. A coil or closure device which is attached to the catheter will then be placed in the PDA. This will stop blood from flowing through the PDA. Once the coil or device is in the correct position, it will be released from the catheter. Then the catheter will be removed Typically this method is used if a child: is older than 6 months, is at least 22 pounds, and has defects that are not too large

‍

When is surgery advised for the treatment of PDA?

Surgery can close PDAs. Surgical closure is often advised for babies younger than 6 months who have large defects and symptoms such as poor weight gain and fast breathing. For babies who don't have symptoms, any surgery may be delayed until after age 6 to 12 months. Your child's cardiologist will advise when the surgery should be done. It is done under general anesthesia so you child will be asleep. Surgery closes the PDA with stitches or clips. This stops the extra blood from getting into the lungs. Premature babies must have this surgery.