Patent Ductus Arteriosus (PDA) in Cardiology

Introduction

Patent Ductus Arteriosus (PDA) is a congenital heart defect in which a fetal blood vessel, the ductus arteriosus, fails to close after birth. This condition allows abnormal blood flow between the aorta and pulmonary artery, potentially leading to serious cardiovascular complications if not treated.

Causes and Risk Factors

• Prematurity (most common in preterm infants)
• Genetic predisposition
• Maternal infections during pregnancy (such as rubella)
• Birth at high altitudes
• Other congenital heart defects

Symptoms

• Mild PDA: Often asymptomatic
• Moderate to Large PDA:
  • Heart murmur (detectable on auscultation)
  • Shortness of breath, rapid breathing
  • Poor weight gain in infants
  • Recurrent respiratory infections
  • Fatigue and weakness
  • Signs of heart failure in severe cases

Diagnosis

• Echocardiography (primary diagnostic tool)
• Chest X-ray (may show cardiomegaly, pulmonary congestion)
• Electrocardiogram (ECG) (can indicate left atrial or ventricular enlargement)
• Cardiac catheterization (in selected cases)

Treatment

1. Medical Management

• In preterm infants, PDA may close spontaneously or with medication (e.g., NSAIDs like indomethacin or ibuprofen)

• Diuretics to manage symptoms

  2. Interventional Closure

• Catheter-based procedures: Closure with PDA occluders or coils (preferred in many cases)

  3. Surgical Closure

• Recommended when catheter-based methods are not feasible

• Involves ligation or division of the ductus arteriosus

Prognosis and Long-Term Outlook

With timely diagnosis and appropriate treatment, the prognosis for PDA is generally excellent. Untreated, PDA can result in complications such as pulmonary hypertension, infective endocarditis, and heart failure.

Prevention

• Preventing preterm birth when possible
• Maternal rubella vaccination
• Early screening in high-risk newborns

Conclusion

PDA is a treatable condition with a variety of management options, from observation to surgery. Infants and children with PDA require appropriate monitoring and follow-up care to avoid complications.

Source recommendations

1. 2023 ESC Guidelines for the Management of Adult Congenital Heart Disease

1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Grown-Up-Congenital-Heart-Disease-Management-of
2. https://pubmed.ncbi.nlm.nih.gov/32860028/
3. https://www.jacc.org/doi/10.1016/j.jacc.2021.09.010
4. https://academic.oup.com/eurheartj/pages/esc_guidelines
5. https://www.revespcardiol.org/en-2020-esc-guidelines-for-management-articulo-S1885585721001201

2. 2021 AHA Guidelines for the Management of Congenital Heart Disease

1. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000603
2. https://www.jacc.org/doi/10.1016/j.jacc.2021.09.010
3. https://pubmed.ncbi.nlm.nih.gov/34736567/
4. https://www.heart.org/en/health-topics/congenital-heart-defects
5. https://www.sciencedirect.com/science/article/pii/S073510972106215X