Patent Ductus Arteriosus

A patent ductus arteriosus (PDA) occurs when this fetal shunt fails to close after several days of life. This
remnant of fetal circulation remaining patent occurs more frequently in children born prematurely, with
an incidence ranging from 20% to 60%. If a ductus arteriosus does not close after birth, it allows blood to
flow from the aorta (area of high pressure) through the PDA and into the main pulmonary artery (area of
low pressure). The shunted blood then returns to the left atrium of the heart and repeats the cycle. This
extra blood flow increases pulmonary circulation. This is an acyanotic defect, as the blood flowing from
the aorta is fully oxygenated

Assessment

This defect produces a systolic murmur early in life and a continuous murmur as the child ages. The
murmur is noted at the second intercostal space, left upper sternal border, or out to the left clavicular
area. If the defect is large enough, the flow to the lungs will be significant and can cause rales,
congestion, increased work of breathing, difficulty feeding, or failure to thrive. Over time, the left heart
can become dilated. The severity of the symptoms depends on the amount of blood shunting to the
lungs. A PDA is confirmed with an echocardiogram.

Management

Treatment for a PDA varies. Medical management of a PDA involves addressing the symptoms of the
increased blood flow by prescribing a diuretic such as furosemide. The caloric concentration of the
infant’s feeds may need to be increased in an effort to help the child gain weight. If the child is
experiencing significant manifestations of the increased pulmonary blood flow or if left heart dilation is
noted from the extra blood flow returning to the left side of the heart, the child will be referred for PDA
closure.

If the PDA is noted immediately after birth, indomethacin, a nonsteroidal antiinflammatory and
prostaglandin inhibitor, can be utilized to facilitate closure. This is usually given in three separate IV
doses in the newborn nursery. In older children, a PDA can be closed in the cardiac catheterization lab
with a device placed in the duct to occlude flow. Occasionally, a duct needs to be closed surgically either
for a premature baby who is too small to undergo closure in the catheterization lab or due to other
confounding factors. Surgical closure of a PDA is done via a left-sided thoracotomy incision and does not
require cardiopulmonary bypass.