patent ductus arteriosus new

8/8/2019 Patent Ductus Arteriosus New

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Patent ductus arteriosus (PDA) is a congenitalheart defect wherein a neonate's ductus

arteriosus fails to close afterbirth. Symptoms are uncommon but in the first year of life include

increased work of breathing and poor weight gain. With age, the PDA may lead to congestiveheart failure if left uncorrected.

Etiology

A patent ductus arteriosus can be idiopathic (i.e. without an identifiable cause), or secondary toanother condition. Some common contributing factors in humans include: - Premature infants -Congenital rubella syndrome - Chromosomal abnormalities such as Down Syndrome

Normal ductus arteriosus closure

In the developing fetus, the ductus arteriosus (DA) is the vascular connection between the

pulmonary artery and the aortic arch that allows most of the blood from the right ventricle to

bypass the fetus' fluid-filled compressed lungs. During fetal development, this shunt protects the

right ventricle from pumping against the high resistance in the lungs, which can lead to rightventricular failure if the DA closes in-utero.

When the newborn takes its first breath, the lungs open and pulmonary vascular resistance

decreases. After birth, the lungs release bradykinin to constrict the smooth muscle wall of the

DA and reduce bloodflow through the DA as it narrows and completely closes, usually withinthe first few weeks of life. In most newborns with a patent ductus arteriosus the blood flow is

reversed from that of in utero flow, ie. the blood flow is from the higher pressure aorta to the

now lower pressure pulmonary arteries.
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In normal newborns, the DA is substantially closed within 12-24 hours after birth, and is

completely sealed after three weeks. The primary stimulus for the closure of the ductus is the

increase in neonatal blood oxygen content. Withdrawal from maternal circulating maternalprostaglandins also contributes to ductal closure. The residual scar tissue from the fibrotic

remnants of DA, called the ligamentum arteriosum, remains in the normal adult heart.

Patent ductus arteriosus

Patent ductus arteriosus, or PDA, is a heart condition that is normal but reverses soon after birth.

In a persistent PDA, there is an irregular transmission of blood between two of the mostimportant arteries in close proximity to the heart. Although the ductus arteriosus normally seals

off within a few days, in PDA, the newborn's ductus arteriosus does not close but remains patent.

PDA is common in neonates with persistent respiratory problems such as hypoxia, and has a highoccurrence in premature children. In hypoxic newborns, too little oxygen reaches the lungs to

produce sufficient levels of bradykinin and subsequent closing of the DA. Premature children are

more likely to be hypoxic and thus have PDA because of their underdeveloped heart and lungs.

A patent ductus arteriosus allows that portion of the oxygenated blood from the left heart to flowback to the lungs (following the pressure gradient from the higher pressure aorta to the

pulmonary arteries). If this shunt amount is substantial, the neonate becomes short of breath

because there is not only the normal amount of unoxygenated blood that has returned from the

body to go to the lungs but in addition there is the amount shunted through the PDA. Theneonate's work of breathing is increased, using up more calories and often interfering with

feeding in infancy. This condition as a constellation of findings is called congestive heart failure.

In some cases, such as in transposition of the great vessels (the pulmonary artery and the aorta), aPDA may need to remain open. In this cardiovascular condition, the PDA is the only way that

oxygenated blood can mix with deoxygenated blood. In these cases, prostaglandins are used tokeep the patent ductus arteriosus open.

Prognosis

Without treatments, Disease may progress from left-to-right(noncyanotic heart) shunt to right-to-

left shunt(cyanotic heart) called Eisenmenger syndrome.

Signs and symptoms

While some cases of PDA are asymptomatic, common symptoms include:

tachycardiaor other arrhythmia respiratoryproblems shortness of breath continuous machine-like murmur enlarged heart Left subclavicular thrill Bounding pulse
http://en.wikipedia.org/wiki/Prostaglandinshttp://en.wikipedia.org/wiki/Ligamentum_arteriosumhttp://en.wikipedia.org/wiki/Hearthttp://en.wikipedia.org/wiki/Arterieshttp://en.wikipedia.org/wiki/Ductus_arteriosushttp://en.wikipedia.org/wiki/Respiration_(physiology)http://en.wikipedia.org/wiki/Hypoxia_(medical)http://en.wikipedia.org/wiki/Premature_birthhttp://en.wikipedia.org/wiki/Oxygenhttp://en.wikipedia.org/wiki/Pressure_gradienthttp://en.wikipedia.org/wiki/Congestive_heart_failurehttp://en.wikipedia.org/wiki/Prostaglandinhttp://en.wikipedia.org/wiki/Tachycardiahttp://en.wikipedia.org/wiki/Arrhythmiahttp://en.wikipedia.org/wiki/Respiration_(physiology)http://en.wikipedia.org/wiki/Dyspneahttp://en.wikipedia.org/wiki/Heart_murmurhttp://en.wikipedia.org/wiki/Cardiomegalyhttp://en.wikipedia.org/wiki/Bounding_pulse


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Widened pulse pressure [1] Poor growth [2]

Treatment

Neonates without adverse symptoms may simply be monitored as outpatients, whilesymptomatic PDA can be treated with both surgical and non-surgical methods.[3] Surgically, theDA may be closed by ligation, wherein the DA is manually tied shut, or with intravascular coils

or plugs that leads to formation of a thrombus in the DA. This was first performed in humans by

Robert E. Gross. Because Prostaglandin E-2 is responsible for keeping the ductus patent,inhibitors of prostaglandin synthesis such as Indomethacin have been used to help close a PDA.

This is an especially viable alternative for premature infants.

In certain cases it may be beneficial to the neonate to prevent closure of the ductus arteriosus.

For example, in transposition of the great vessels, a PDA may prolong the newborn's life untilsurgical correction is possible. The ductus arteriosus can be induced to remain open by

administering prostaglandin analogs such as alprostadil or misoprostol (prostaglandin E1analogs).

More recently, PDAs can be closed by percutaneous interventional method. Via the femoral veinor femoral artery, a platinum coil can be deployed via a catheter, which induces thrombosis (coil

embolization). Alternatively, a PDA occluder device (AGA Medical), composed of nitinol mesh,

is deployed from the pulmonary artery through the PDA. The larger skirt of the device sits on theaortic side while the ampulla of the device hugs the walls of the PDA, with care taken to avoid

occlusion of the pulmonary arterial lumen by the device. These methods permit closure without

open heart surgery.

http://en.wikipedia.org/wiki/Patent_ductus_arteriosus

Patent ductus arteriosus (PDA) accounts for 5 to 10% of congenital heart anomalies;the male:female ratio is 1:3. PDA is very common among premature infants (in 45%with birth weight < 1750 g; in about 80% with birth weight < 1200 g). SignificantPDA causes heart failure (HF) in 15% of premature infants with birth weight < 1750g and in 40 to 50% of those with birth weight < 1500 g

Treatment

In premature infants with compromised respiratory status, the PDA can sometimes be closed byusing a prostaglandin synthesis inhibitor (eg, indomethacin Some Trade Names

INDOCINCongenital Cardiovascular Anomalies: Indomethacin Dosing Guidelines (mg/kg) for doses] IV

q 12 h for 3 doses; or ibuprofen Some Trade Names

ADVILMOTRIN

NUPRIN
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10 mg/kg po followed by 2 doses of 5 mg/kg at 24-h intervals) with or without fluid restriction.

If this treatment is ineffective, surgical ligation is indicated.

Table 4

Indomethacin Dosing Guidelines

(mg/kg)Age AtDose 1

Dose 1 Dose 2 Dose 3

< 48 h 0.2 0.1 0.1

27 days 0.2 0.2 0.2> 7 days 0.2 0.25 0.25

In full-term infants, indomethacin Some Trade Names

INDOCIN is usually ineffective. For a large PDA, surgical ligation and division are typicallydone electively at age 6 mo to 3 yr. If HF develops, surgery can be done earlier after medical

management for HF. Nonsurgical options for PDA closure include various catheter-delivered

occlusion devices (percutaneous coil occlusion, Amplatzer duct occluder, Rashkind umbrelladevice). These techniques have become the treatment of choice in children > 1 yr. Outcomes

after PDA closure are excellent.

Before and for 6 to 12 mo after surgical or catheter-based PDA closure, all patients require

endocarditis prophylaxis (see Table 4: Endocarditis: Recommended Endocarditis ProphylaxisDuring Oral-Dental, Respiratory Tract, or Esophageal Procedures* ) before dental or surgical

procedures. Patients with a residual shunt require prophylaxis indefinitely.

http://www.merck.com/mmpe/sec19/ch287/ch287e.html

PATENT DUCTUS ARTERIOSUS (PDA)

The ductus arteriosus is a normal fetal structure, allowingblood to bypass circulation to the lungs. Since the fetus

does not use his/her lungs (oxygen is provided through themothers placenta), flow from the right ventricle needs an

outlet. The ductus provides this, shunting flow from the left
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pulmonary artery to the aorta just beyond the origin of theartery to the left subclavian artery. The high levels of

oxygen which it is exposed to after birth causes it to close inmost cases within 24 hours. When it doesnt close, it is

termed a Patent Ductus Arteriosus.

The defect often corrects itself within several months ofbirth, but may require infusion of chemicals, the placementof "plugs" via catheters, or surgical closure.

The flow pattern is similar to the septal defects notedabove, except that the shunting occurs outside of the heart.The left ventricle has to pump blood out through the aorta,only to have some of it flow to the lower pressure pulmonaryartery, and directly back to the left atrium and ventricle. If alarge PDA is not corrected, then the pressures in thepulmonary arteries may become very high and inducechanges in the arteries themselves such that even closure ofthe defect will no longer improve the patient. In this case,the pressures in the right side of the heart are high enoughthat blood may begin to flow from the right to the left side

of the heart. This situation is called "Eisenmengerssyndrome", a condition which may result from severalsimilar abnormalites.

http://www.heartpoint.com/congpda.html

Treatments and drugs

By Mayo Clinic staff

In a premature infant, the patent ductus arteriosus often closes on its own in the weeks after birth. Ina full-term infant, a patent ductus arteriosus usually will close within the first few days of life. If thedefect doesn't close and is causing health problems, medications or surgery may be used to close it.

MedicationsDoctors use nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or indomethacin, tohelp close a patent ductus arteriosus in premature infants. NSAIDs block the hormone-like chemicalsin the body that keep the PDA open.
http://www.mayoclinic.com/health/AboutThisSite/AM00057


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SurgerySurgery to repair a patent ductus arteriosus involves patching or sewing shut the abnormal opening.This can be done through an incision in the side of the chest or by catheterization. In cardiaccatheterization, a thin tube (catheter) is inserted into a blood vessel in the groin and threaded up tothe heart. Through the catheter, a plug or coil may be deployed to close the ductus arteriosus. Insurgery, the ductus is closed with a metal clip.

Preventive antibioticsIn the past, it was recommended that people with an unrepaired patent ductus arteriosus takeantibiotics before dental work and certain types of surgical procedures to prevent infectiveendocarditis.

But new guidelines issued by the American Heart Association in 2007 have substantially revised thisrecommendation. After weighing the risks and benefits of preventive antibiotics, the reviewingcommittee found that the risks outweighed the benefits for most people, except a small group at highrisk of serious complications of infectious endocarditis.

The reviewers found that random germs caused infectious endocarditis more frequently than didroutine dental or medical procedures. They suggest a more effective strategy for preventingendocarditis may be to practice good oral hygiene and get regular dental checkups. They also noted

that taking preventive antibiotics carries certain uncommon though possible risks, such as an allergicreaction, and may contribute to growing antibiotic resistance.

Because of these changes, preventive antibiotics are no longer recommended for many people with apatent ductus arteriosus. However, some people still need antibiotics, such as those who:

Have other heart conditions or artificial valves

Have a large defect that's causing a low blood oxygen level

Have had repair with prosthetic material

If you've been told you or your child needed to take antibiotics before any procedures in the past, talkwith your doctor about how these new recommendations apply to you.

http://www.mayoclinic.com/health/patent-ductus-arteriosus/DS00631/DSECTION=treatments%2Dand%2Ddrugs

When PDA is suspected, a patient may undergo a series of tests such as:

Echocardiogram. This test uses sound waves to visualize the structures and functions of

the heart. A moving image of the patients beating heart is displayed on a video screen,

where a physician can study the hearts thickness, size and function. The image also

shows the motion pattern and structure of the four heart valves, revealing any potentialleakage (regurgitation) or narrowing (stenosis). During this test, a Doppler ultrasound

may be done to evaluate blood flow through the PDA. This is the definitive test indiagnosing a PDA. It may also help in judging the significance of the defect and whether

there are any other associated malformations.
http://www.mayoclinic.com/health/patent-ductus-arteriosus/DS00631/DSECTION=treatments-and-drugshttp://www.mayoclinic.com/health/patent-ductus-arteriosus/DS00631/DSECTION=treatments-and-drugs


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Chest x-ray. A radiation-based imaging test that offers the physician a picture of the

general size, shape, and structure of the heart and lungs. This test may show congestionof the lungs because of increased fluid.

Electrocardiogram (EKG). A recording of the heart's electrical activity as a graph on a

moving strip of paper or video monitor. The highly sensitive electrocardiograph machinehelps detect heart irregularities, disease and damage by measuring the heart's rhythms and

electrical impulses. This test is generally normal in the child with a PDA unless the defect

is so large that there is considerable, chronic overwork to the pulmonary blood vesselsand left ventricle.

Among premature infants, PDA can possibly be detected by such symptoms as troubled

breathing, abnormal heart rhythm and other symptoms of heart failure.

http://yourtotalhealth.ivillage.com/patent-ductus-arteriosus.html?pageNum=6

GENERIC NAME: indomethacin
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BRAND NAME: Indocin, Indocin-SR

DRUG CLASS AND MECHANISM: Indomethacin is a nonsteroidal anti-inflammatory drug(NSAID) that reduces fever, pain and inflammation. It is similar to ibuprofen (Motrin) and

naproxen (Naprosyn, Aleve). Indomethacin works by reducing the production of prostaglandins.

Prostaglandins are chemicals that the body produces to cause fever and pain that are associatedwith inflammation. Indomethacin blocks the enzymes that make prostaglandins (cyclooxygenase1 and 2) and thereby reduces the levels of prostaglandins. As a result, fever, pain and

inflammation are reduced. Indomethacin is available in a sustained (slow) release form (Indocin-

SR). The FDA first approved indomethacin in January 1965.

PRESCRIBED FOR: Indomethacin is used for the treatment of inflammation causedby rheumatoid arthritis, ankylosing spondylitis, gouty arthritis, osteoarthritis, andsoft tissue injuries such as tendinitis and bursitis.

GENERIC NAME: ibuprofen

BRAND NAME: Advil, Children's Advil/Motrin, Medipren, Motrin, Nuprin,

PediaCare Fever etc.

DRUG CLASS AND MECHANISM: Ibuprofen belongs to a class of drugs called non-steroidal anti-inflammatory drugs (NSAIDs). Other members of this class include aspirin,

naproxen (Aleve), indomethacin (Indocin), nabumetone (Relafen) and several others. These

drugs are used for the management of mild to moderate pain, fever, and inflammation. Pain,fever, and inflammation are promoted by the release in the body of chemicals called

prostaglandins. Ibuprofen blocks the enzyme that makes prostaglandins (cyclooxygenase),

resulting in lower levels of prostaglandins. As a consequence, inflammation, pain and fever are

reduced. The FDA approved ibuprofen in 1974.

PRESCRIBED FOR: Ibuprofen is used for the treatment of mild to moderate pain,inflammation and fever caused by many and diverse diseases.

USES: Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID), which relievespain and swelling (inflammation). It is used to treat headaches, muscle aches,backaches, dental pain, menstrual cramps, arthritis, or athletic injuries. Thismedication is also used to reduce fever and to relieve minor aches and pain due tothe common cold or flu. This drug works by blocking the enzyme in your body thatmakes prostaglandins. Decreasing prostaglandins helps to reduce pain, swelling,and fever.

http://www.medicinenet.com/ibuprofen-oral/article.htm

Pathophysiology
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The murmur in patent ductus arteriosus is characterized as being systolic and diastolic with a

crescendo and decrescendo pattern, peaking at around the closure of the aortic valve (A2). Due to

the left-to-right shunting at the patent ductus arteriosus the pulmonary venous return will beincreased causing dilatation of the left atrium and stretching of the patent foramen ovale with

more left-to-right shunting at the atrial level worsening congestive heart failure. The patent

ductus arteriosus murmur is best heard over the second left intercostal space. Clicking noisesduring the murmur gives the characteristic machinery quality of the patent ductus arteriosus

murmur.

Murmurs mimicking patent ductus arteriosus include AP window, venous hum, ruptured sinus of

Valsalva (aorta to RA, RV or LA shunts), coronary artery to ventricular cavity fistula andtetralogy of Fallot with pulmonary atresia and large collaterals.

Patients present with congestive heart failure, this include easy fatigability (poor feeding in

infants), shortness of breath, pallor sweating and cool extremities with exertion. Signs include

bounding pulses, increase left ventricular apical impulse, thrill, continuous murmur and

pulmonary sounds consistent with pulmonary edema such as rales and wheezing.

http://pediatriccardiology.uchicago.edu/MP/CHD/PDA/PDA.htm

Prognosis

In premature babies with significant PDA there is risk of broncho-pulmonary dysplasia. If a child

with RDS is found to have PDA too this is an adverse prognostic sign.13 If a premature infant

does not have RDS or it is uncomplicated, the timing of spontaneous closure of the ductus isnormal.14 In most patients who have had successful closure of a PDA there are no further

complications.

http://www.patient.co.uk/doctor/Patent-Ductus-Arteriosus.html

RN interventions would be: assessment of vitals & signs such as tachycardia,tachypnea, scalp diaphoresis (signs CHF), I/O and weight (weigh diapers, check fluidretention), monitor for edema, position bed in semi-fowlers if necessary, avoid coldstress in infant (always keep infants warm!), reduce environmental stimuli...rest!,O2 if RX, organize RN actions to promote uninterrupted sleep (think about this whenentering room & infant is sleeping...what do you do first? Do things you don't needto wake infant for in priority). administer RX, Instruct parents (don't forget CPR andSDS teaching). Basically...the RN should activate all care usually associated withCHF because anormal communicaiton between these larger arteries is going to

permit bloodflow from the left side of the heart (high pressure) to the right side (lowpressure). If you don't understand this, then you need to revise your cardiavphysiology!

http://wiki.answers.com/Q/Nursing_interventions_fo_patient_having_patent_ductus_arteriosus
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Cardiovascular Disorders

Patent Ductus Arteriosus (PDA)

Click Image to Enlarge

What is a patent ductus arteriosus (PDA)?

PDA is a heart problem that is usually noted in the first few weeks or months after birth. It ischaracterized by a connection between the aorta and the pulmonary artery which allows oxygen-

rich (red) blood that should go to the body to recirculate through the lungs.

All babies are born with this connection between the aorta and the pulmonary artery. While your

baby was developing in the uterus, it was not necessary for blood to circulate through the lungsbecause oxygen was provided through the placenta. During pregnancy, a connection was

necessary to allow oxygen-rich (red) blood to bypass your baby's lungs and proceed into the

body. This normal connection that all babies have is called a ductus arteriosus.

At birth, the placenta is removed when the umbilical cord is cut. Your baby's lungs must nowprovide oxygen to his/her body. As your baby takes the first breath, the blood vessels in the

lungs open up, and blood begins to flow through to pick up oxygen. At this point, the ductus

arteriosus is not needed to bypass the lungs. Under normal circumstances, within the first fewdays or weeks after birth, the ductus arteriosus closes and blood no longer passes through it.

Most babies have a closed ductus arteriosus by 72 hours after birth.


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Click Image to Enlarge

In some babies, however, the ductus arteriosus remains open (patent) and becomes a problem,

PDA. The opening between the aorta and the pulmonary artery allows oxygen-rich (red) blood to

pass back through the blood vessels in the lungs.

PDA is the sixth most common congenital heart defect, occurring in 6 to 11 percent of allchildren with congenital heart disease. Patent ductus arteriosus occurs twice as often in girls as in

boys.

What causes patent ductus arteriosus?

In many children, there is no known reason for the ductus arteriosus remaining open. However,

PDA is seen more often in the following:

premature infants

infants born to a mother who had rubella during the first trimester ofpregnancy

Some congenital heart defects may have a genetic link, either occurring due to a defect in a gene,

a chromosome abnormality, or environmental exposure, causing heart problems to occur more

often in certain families. Most often, a PDA occurs sporadically (by chance), with no clearreason for its development.

PDA can also occur in combination with other heart defects.

Why is PDA a concern?

When the ductus arteriosus stays open, oxygen-rich (red) blood passes from the aorta to the

pulmonary artery, mixing with the oxygen-poor (blue) blood already flowing to the lungs. The

blood vessels in the lungs have to handle a larger amount of blood than normal. How well the

lung vessels are able to adapt to the extra blood flow depends on how big the PDA is and howmuch blood is able to pass through it from the aorta.


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Extra blood causes higher pressure in the blood vessels in the lungs. The larger the volume of

blood that goes to the lungs, the higher the pressure. The lungs are able to cope with this extra

blood flow and pressure for a while, depending on exactly how high the pressure is. Withoutmedical treatment, however, the blood vessels in the lungs become diseased by the extra

pressure.

Further, because blood is pumped at high pressure through the PDA, the lining of the pulmonary

artery will become irritated and inflamed. Bacteria in the bloodstream can easily infect thisinjured area, causing a serious illness known as bacterial endocarditis.

What are the symptoms of a patent ductus arteriosus?

The size of the connection between the aorta and the pulmonary artery will affect the type of

symptoms noted, the severity of symptoms, and the age at which they first occur. The larger the

opening, the greater the amount of blood that passes through that overloads the lungs.

A child with a small patent ductus arteriosus might not have any symptoms, and your child'sphysician may have only noted the defect by hearing a heart murmur. Other infants with a larger

PDA may exhibit different symptoms. The following are the most common symptoms of PDA.

However, each child may experience symptoms differently. Symptoms may include:

fatigue sweating rapid breathing heavy breathing congested breathing disinterest in feeding, or tiring while feeding poor weight gain

The symptoms of a PDA may resemble other medical conditions or heart problems. Always

consult your child's physician for a diagnosis.

How is a patent ductus arteriosus diagnosed?

Your child's physician may have heard a heart murmur during a physical examination, and

referred your child to a pediatric cardiologist for a diagnosis. A heart murmur is simply a noisecaused by the turbulence of blood flowing through the opening from the left side of the heart to

the right.

A pediatric cardiologist specializes in the diagnosis and medical management of congenital heart

defects, as well as heart problems that may develop later in childhood. The cardiologist willperform a physical examination, listening to the heart and lungs, and make other observations

that help in the diagnosis. The location within the chest where the murmur is heard best, as well

as the loudness and quality of the murmur (harsh, blowing, etc.) will give the cardiologist aninitial idea of which heart problem your child may have. However, other tests are needed to help

with the diagnosis, and may include the following:


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chest x-ray - a diagnostic test which uses invisible electromagnetic energybeams to produce images of internal tissues, bones, and organs onto film.With a PDA, the heart may be enlarged due to larger amounts of blood flowthrough the lungs than normal. Also, there may be changes that take place inthe lungs due to extra blood flow that can be seen on an x-ray.

electrocardiogram (ECG or EKG) - a test that records the electrical activity of

the heart, shows abnormal rhythms (arrhythmias or dysrhythmias), anddetects heart muscle stress.

echocardiogram (echo) - a procedure that evaluates the structure andfunction of the heart by using sound waves recorded on an electronic sensorthat produce a moving picture of the heart and heart valves. An echo canshow the pattern of blood flow through the PDA, and determine how large theopening is, as well as how much blood is passing through it.

cardiac catheterization - a cardiac catheterization is an invasive procedurethat gives very detailed information about the structures inside the heart.Under sedation, a small, thin, flexible tube (catheter) is inserted into a bloodvessel in the groin, and guided to the inside of the heart. Blood pressure andoxygen measurements are taken in the four chambers of the heart, as well as

the pulmonary artery and aorta. Contrast dye is also injected to more clearlyvisualize the structures inside the heart.

The cardiac catheterization procedure may also be an option for treatment.During the procedure, the child is sedated and a small, thin, flexible tube(catheter) is inserted into a blood vessel in the groin and guided to the insideof the heart. Once the catheter is in the heart, the cardiologist will pass aspecial device, called a coil or occluder, into the open PDA preventing bloodfrom flowing through it.

Treatment for patent ductus arteriosus:

Specific treatment for PDA will be determined by your child's physician based on:

your child's age, overall health, and medical history extent of the disease your child's tolerance for specific medications, procedures, or therapies expectations for the course of the disease your opinion or preference

A small patent ductus arteriosus may close spontaneously as your child grows. A PDA thatcauses symptoms will require medical management, and possibly even surgical repair. Your

child's cardiologist will check periodically to see whether the PDA is closing on its own. If a

PDA does not close on its own, it will be repaired to prevent lung problems that will developfrom long-time exposure to extra blood flow. Treatment may include:

medical managementIn premature infants, an intravenous (IV) medication called indomethacinmay help close a patent ductus arteriosus. Indomethacin is related to aspirinand ibuprofen and works by stimulating the muscles inside the PDA toconstrict, thereby closing the connection. Your child's physician can answer


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any further questions you may have about this treatment.

As previously mentioned, some children will have no symptoms, and requireno medications. However, others may need to take medications to help theheart and lungs work better. Medications that may be prescribed include thefollowing:

o digoxin - a medicine that helps strengthen the heart muscle, enablingit to pump more efficiently.

o diuretics - the body's water balance can be affected when the heart isnot working as well as it could. These medications help the kidneysremove excess fluid from the body.

adequate nutritionMost infants with PDA eat and grow normally, but premature infants or thoseinfants with a large PDA may become tired when feeding, and are not able toeat enough to gain weight. Options that can be used to ensure your baby willhave adequate nutrition include the following:

o high-calorie formula or breast milkSpecial nutritional supplements may be added to formula or pumpedbreast milk that increase the number of calories in each ounce,thereby allowing your baby to drink less and still consume enoughcalories to grow properly.

o supplemental tube feedingsFeedings given through a small, flexible tube that passes through thenose, down the esophagus, and into the stomach, can eithersupplement or take the place of bottle-feedings. Infants who can drinkpart of their bottle, but not all, may be fed the remainder through thefeeding tube. Infants who are too tired to bottle-feed may receive theirformula or breast milk through the feeding tube alone.

PDA repair or closureThe majority of infants and children with PDA are candidates for repair in thecardiac cath lab. The goal is to repair the PDA before the lungs becomediseased from too much blood flow and pressure.

Repair is usually indicated in infants younger than 6 months of age who havelarge defects that are causing symptoms, such as poor weight gain and rapidbreathing. For infants who do not exhibit symptoms, the repair may often bedelayed until after 6 months of age. Your child's cardiologist will recommendwhen the repair should be performed.

Transcatheter coil closure of the PDA is frequently used because it isminimally invasive. However, premature infants are not candidates for this

procedure.Your child's PDA may be repaired surgically in the operating room. Thesurgical repair, also called PDA ligation, is performed under generalanesthesia. The procedure involves closing the open PDA with stitches toprevent the surplus blood from entering your child's lungs. Alternately, thevessel connecting the aorta and pulmonary artery may be cut and cauterized(sealed off by burning with an electrical instrument).

Post-procedure care for your child:


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You will receive additional instructions from your child's physicians and the hospital staff.

Long-term outlook after PDA surgical repair:

In premature infants, the outlook after PDA surgical repair depends on the following:

your child's gestational age any other illnesses present in your baby

In children born full-term, most that had a patent ductus arteriosus diagnosed and repaired early

will live healthy lives after recovering from the hospitalization. Activity levels, appetite, and

growth should return to normal. Your child's cardiologist may recommend that antibiotics begiven to prevent bacterial endocarditis for a specific time period after discharge from the hospital

if the coil or occluder device was used.

In children whose PDA was diagnosed late and/or never repaired, the outlook is uncertain. There

is a risk for pulmonary hypertension (increased blood pressure in the blood vessels of the lungs).These individuals should receive follow-up care at a center that specializes in congenital heart

disease.

Consult your child's physician regarding the specific outlook for your child.

Click here to view the

Online Resources of Cardiovascular Disorders

http://www.healthsystem.virginia.edu/uvahealth/peds_cardiac/pda.cfm
http://www.healthsystem.virginia.edu/uvahealth/peds_cardiac/online.cfm

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