Patent ductus arteriosus (PDA) is a congenital heart defect wherein the ductus arteriosus fails

to close after birth. Early symptoms are uncommon, but in the first year of life include increased
work of breathing and poor weight gain. An uncorrected PDA may lead to congestive heart
failure with increasing age.
Signs and symptoms
Common symptoms include:
Tachycardia (a heart rate exceeding the normal resting rate)
Respiratory problems
Dyspnea (shortness of breath)
Continuous machine-like heart murmur (usually from aorta to pulmonary artery, with higher
flow during systole and lower flow during diastole)
Cardiomegaly (enlarged heart, reflecting ventricular dilation and volume overload)
Left subclavicular thrill
Bounding pulse
Widened pulse pressure
Poor growth
Differential cyanosis, i.e. cyanosis of the lower extremities but not of the upper body.
Patients typically present in good health, with normal respirations and heart rate. If the PDA is
moderate or large, widened pulse pressure and bounding peripheral pulses are frequently present,
reflecting increased left ventricular stroke volume and diastolic run-off of blood into the (initially
lower-resistance) pulmonary vascular bed. Prominent suprasternal and carotid pulsations may be
noted secondary to increased left ventricular stroke volume
Cause
A PDA is sometimes idiopathic. Known risk factors include:
Preterm birth
Congenital rubella syndrome
Chromosomal abnormalities (e.g., Down syndrome)
Genetic conditions such as Loeys-Dietz syndrome (would also present with other heart defects)
Diagnosis
Phonocardiograms from normal and abnormal heart sounds
Noninvasive techniques
Echocardiography (in which sound waves are used to capture the motion of the heart)
Electrocardiography
A chest X-ray may be taken, which reveals overall heart size (as a reflection of the combined
mass of the cardiac chambers) and the appearance of blood flow to the lungs.
Small PDA normal sized heart and normal blood flow to the lungs
LARGE pda - enlarged cardiac silhouette and increased blood flow to the lungs.
Prevention

indomethacin administration on the first day of life to all preterm infants reduces the risk of
developing a PDA and the complications associated with PDA.
Treatment
While symptomatic PDA can be treated with both surgical and non-surgical methods.
Surgically, the DA may be closed by ligation (though support in premature infants is mixed),
either manually tied shut, or with intravascular coils or plugs that leads to formation of a
thrombus in the DA.
PDAs can be closed by percutaneous interventional method (avoiding open heart surgery). A
platinum coil can be deployed via a catheter through the femoral vein or femoral artery, which
induces thrombosis (coil embolization). Alternatively, a PDA occluder device, composed of
nitinol mesh, is deployed from the pulmonary artery through the PDA.