Learn about symptoms, causes and treatment of patent ductus arteriosus, a common — and treatable — heart defect that occurs shortly after birth.
Patent ductus arteriosus (PDA) is a persistent opening between the two major blood vessels leading from the heart. The opening (ductus arteriosus) is a normal part of a baby's circulatory system in the womb that usually closes shortly after birth. If it remains open, it's called a patent ductus arteriosus.
A small patent ductus arteriosus often doesn't cause problems and might never need treatment. However, a large patent ductus arteriosus left untreated can allow poorly oxygenated blood to flow in the wrong direction, weakening the heart muscle and causing heart failure and other complications.
Treatment options for a patent ductus arteriosus include monitoring, medications, and closure by cardiac catheterization or surgery.
Patent ductus arteriosus symptoms vary with the size of the defect and whether the baby is full term or premature. A small PDA might cause no signs or symptoms and go undetected for some time — even until adulthood. A large PDA can cause signs of heart failure soon after birth.
Your baby's doctor might first suspect a heart defect during a regular checkup after hearing a heart murmur while listening to your baby's heart through a stethoscope.
A large PDA found during infancy or childhood might cause:
Contact the doctor if your baby or older child:
Congenital heart defects arise from problems early in the heart's development — but there's often no clear cause. Genetic factors might play a role.
Before birth, an opening that connects two major blood vessels leading from the heart — the aorta and pulmonary artery — is necessary for a baby's blood circulation. The connection diverts blood from a baby's lungs while they develop, and the baby receives oxygen from the mother's circulation.
After birth, the ductus arteriosus normally closes within two or three days. In premature infants, the opening often takes longer to close. If the connection remains open, it's referred to as a patent ductus arteriosus.
The abnormal opening causes too much blood to flow to the baby's lungs and heart. Untreated, the blood pressure in the baby's lungs might increase (pulmonary hypertension) and the baby's heart might enlarge and weaken.
Risk factors for having a patent ductus arteriosus include:
A small patent ductus arteriosus might not cause complications. Larger, untreated defects could cause:
Most women who have a small patent ductus arteriosus can tolerate pregnancy without problems. However, having a larger defect or complications — such as heart failure, arrhythmias or pulmonary hypertension — can increase the risk of complications during pregnancy. If you have Eisenmenger syndrome, pregnancy should be avoided as it can be life-threatening.
If you have a heart defect, repaired or not, discuss family planning with your doctor. In some cases, preconception consultations with doctors who specialize in congenital cardiology, genetics and high-risk obstetric care are needed. Some heart medications can cause serious problems for a developing baby, and it might be necessary to stop or adjust the medications before you become pregnant.
There's no sure way to prevent having a baby with a patent ductus arteriosus. However, it's important to do everything possible to have a healthy pregnancy. Here are some of the basics:
If you have a family history of heart defects or other genetic disorders, consider talking with a genetic counselor before becoming pregnant.
The doctor might suspect that you or your child has a patent ductus arteriosus based on you or your child's heartbeat. A PDA can cause a heart murmur that the doctor can hear through a stethoscope.
If the doctor suspects a heart defect, he or she might request one or more of the following tests:
Cardiac catheterization. This test isn't usually necessary for diagnosing a PDA alone, but it might be done to examine other congenital heart defects found during an echocardiogram or if a catheter procedure is being considered to treat a PDA.
A thin, flexible tube (catheter) is inserted into a blood vessel at your or your child's groin or arm and guided through it into the heart. Through catheterization, the doctor may be able to do procedures to close the patent ductus arteriosus.
Treatments for a patent ductus arteriosus depend on the age of the person being treated. Options might include:
Surgical closure. If medications aren't effective and your child's condition is severe or causing complications, surgery might be recommended. A surgeon makes a small cut between your child's ribs to reach your child's heart and repair the open duct using stitches or clips.
After the surgery, your child will remain in the hospital for several days for observation. It usually takes a few weeks for a child to fully recover from heart surgery. Occasionally, surgical closure might also be recommended for adults who have a PDA that's causing health problems. Possible risks of the surgery include hoarseness, bleeding, infection and a paralyzed diaphragm.
Catheter procedures. Premature babies are too small for catheter procedures. However, if your baby doesn't have PDA-related health problems, the doctor might recommend waiting until the baby is older to do a catheter procedure to correct the PDA. Catheter procedures can also be used to treat full-term babies, children and adults.
In a catheter procedure, a thin tube (catheter) is inserted into a blood vessel in the groin and threaded up to the heart. Through the catheter, a plug or coil is inserted to close the ductus arteriosus.
If the procedure is done on an outpatient basis, you or your child probably won't stay overnight in the hospital. Complications from catheter procedures include bleeding, infection, or movement of the plug or coil from where it was placed in the heart.
In the past, people who've had a PDA were advised to take antibiotics before dental work and certain surgical procedures, to prevent endocarditis. Today, preventive antibiotics are no longer recommended for most people with a patent ductus arteriosus.
You or your child may need to take preventive antibiotics the first six months after a catheter repair procedure, if there's still damage after the repair, or if you had an infection in the heart previously. Talk to your doctor about whether you or your child needs to take antibiotics before any procedures.
If you have a PDA, even if you had surgery as a child, you may be at risk of developing complications as an adult. So it's important to have lifelong follow-up care, especially if you had corrective heart surgery.
This follow-up care could be as simple as having periodic checkups with your doctor, or it may involve regular screenings for complications. The important thing is to discuss your care plan with your doctor and make sure you follow all of your doctor's recommendations.
Ideally, a cardiologist trained in treating adults with congenital heart defects will manage your care.
If you or your child has a congenital heart defect or has had surgery to correct one, you might have some concerns about aftercare. Here are some issues you might be thinking about:
A patent ductus arteriosus might be found while your baby is in the hospital after birth or it might be discovered later as an adult, sometimes because of a heart murmur. If your child's pediatrician suspects a PDA, he or she might refer you to a doctor who specializes in treating children with heart conditions (pediatric cardiologist). If your doctor suspects a PDA when you're an adult, you may be referred to a doctor trained in treating heart conditions (cardiologist).
Here's some information to help you get ready for your appointment.
For patent ductus arteriosus, questions to ask include:
Don't hesitate to ask other questions, as well.
The doctor is likely to ask you a number of questions, such as:
January 7th, 2021