Patent Ductus Arteriosus (PDA)

What is patent ductus arteriosus?

• Before the baby is born, the fetus blood does not require passing to lungs to get oxygenated. The ductus arteriosus is a hole that allows skipping the circulation through the lungs.
• If this hole persists even after the birth, it is called patent ductus arteriosus.
• A small patent ductus arteriosus does not cause any serious problems and specific treatment is not required. Whereas, for large ones are to be closed because of further complications.
• This condition is common congenital heart defect 1 in 2500 to 5000 live births.

What are the symptoms of patent ductus arteriosus?

If the ductus arteriosus small, symptoms may not appear until adulthood. For larger defects, the following symptoms can be present.

• Rapid breathing or breathless
• Decreased appetite – poor growth
• Frequent tiredness
• Murmuring
• Rapid or irregular heartbeat
• Sweating while crying and eating

What are the risk factors of patent ductus arteriosus?

• Premature birth
• Rubella infection during pregnancy
• Born at a high altitude
• Girl baby
• Family history
• Genetic conditions such as Down’s syndrome

What are the complications of patent ductus arteriosus?

• Pulmonary hypertension: Greater blood circulation through ductus arteriosus leads to pulmonary hypertension, which can further lead to the irreversible type of pulmonary hypertension known as Eisenmenger syndrome.
• Heart failure: Patent ductus arteriosus can eventually lead to enlargement of the heart and further heart failure.
• Endocarditis: Inflammation of the heart’s inner lining known as infective endocarditis.

How is PDA diagnosed?

• Electrocardiogram
• Echocardiogram
• Chest X-ray
• Physical examination

What are the indications of PDA devise closure?

• Volume overloading of the left atrium and left ventricle
• Risks of endocarditis
• Aneurysm of PDA
• Pulmonary vascular disease

Why device closure preferred over surgical PDA ligation?

• Device closure is simple
• Less morbidity
• Short hospital stay
• PDA is the first congenital heart disease to undergo trans catheter closure

 What are the complications of surgery for PDA?

• Bleeding
• Blood pressure fluctuations
• Respiratory compromise
• Inadvertent left pulmonary artery ligation
• Recurrent laryngeal nerve damage
• Residual shunting

How does PDA treat?

• Conservative management:
• Cyclooxygenase inhibitors (Idiomethacin, ibuprofen) or acetaminophen are used therapeutically to close PDA
• Surgical ligation:
• Surgical ligation is required in case if the patient is not suitable for pharmacological treatment due to risks/adverse effects associated with it.
• Transcatheter closure:
• This is a minimally invasive procedure
• This procedure is performed in patients who weigh <1000g
• Fluid intake between 120-130 ml/kg to limit pulmonary edema with significant PDA

What is the uniqueness of PDA closure by Dr. Raghu?

Dr. Raghu team has performed date 100 PDA device closure procedure. His work on the closure of large PDAs has been presented at the Cardiological Society of India.