Patent Ductus Arteriosus (PDA)

Introduction

Patent Ductus Arteriosus (PDA) is a congenital heart defect in which the ductus arteriosus, a blood vessel that normally closes shortly after birth, remains open. This can lead to abnormal circulation between the aorta and pulmonary artery, potentially causing heart strain and other complications.

Causes and Risk Factors

  • Prematurity (common in preterm infants)
  • Genetic factors or congenital syndromes (e.g., Down syndrome)
  • Maternal infections during pregnancy (e.g., rubella)
  • Hypoxia or respiratory distress in newborns

Symptoms

Symptoms of PDA depend on its size: - Small PDA: Often asymptomatic and may close spontaneously - Large PDA: Can cause symptoms such as: - Shortness of breath (dyspnea) - Frequent respiratory infections - Poor weight gain - Heart murmur (detectable via auscultation) - Fatigue, especially during feeding in infants

Diagnosis

  • Echocardiography (Ultrasound of the Heart): Gold standard for diagnosis
  • Electrocardiogram (ECG): May show signs of left ventricular hypertrophy
  • Chest X-ray: Can show heart enlargement and increased pulmonary blood flow

Treatment

Treatment depends on the size of the ductus and the presence of symptoms: 1. Observation: Small PDAs may close on their own, requiring only monitoring. 2. Medication: In preterm infants, Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) such as ibuprofen or indomethacin may help close the PDA. 3. Catheter-Based Closure: Using a small coil or device to close the PDA. 4. Surgery: Ligation or clipping of the PDA, usually when other methods fail, or in severe cases.

Potential Complications If Untreated

  • Pulmonary hypertension
  • Heart failure
  • Infective endocarditis
  • Eisenmenger syndrome (in rare cases)

Conclusion

Early detection and treatment of PDA can prevent serious complications and improve long-term outcomes. If a PDA is suspected, a cardiologist will determine the best approach based on the patient’s clinical presentation and diagnostic findings.

References and Guidelines

Source recommendations

1. American Heart Association Guidelines for Congenital Heart Defects

  1. https://www.heart.org/en/health-topics/congenital-heart-defects
  2. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000603
  3. https://www.heart.org/en/health-topics/congenital-heart-defects/about-congenital-heart-defects
  4. https://professional.heart.org/en/guidelines-and-statements
  5. https://newsroom.heart.org/news/as-people-born-with-congenital-heart-defects-now-live-longer-challenges-evolve-over-time

2. European Society of Cardiology Guidelines on the Management of Congenital Heart Diseases

  1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Grown-Up-Congenital-Heart-Disease-Management-of
  2. https://academic.oup.com/eurheartj/article/42/6/563/5898606
  3. https://pubmed.ncbi.nlm.nih.gov/32860028/
  4. https://www.jacc.org/doi/10.1016/j.jacc.2021.09.010
  5. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000603

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