The ductus arteriosus is a blood vessel that allows blood to flow around the baby’s lungs before birth. Shortly after the child is born and the lungs fill with air, the ductus arteriosus is no longer needed. The blood vessel usually closes a few days after birth. If this does not close, the condition is patent ductus arteriosus (PDA). Symptomatic patients experience shortness of breath, feeding problems and breathing problems, among other things. If the opening does not close, the doctor will use medication, a medical procedure and/or surgery. Left untreated, the disease leads to heart problems over time, so treatment is certainly necessary in a timely manner to achieve the best results.
- Causes of non-closure of blood vessel
- Risk factors of patent ductus arteriosus
- Congenital heart disease
- Chromosomal disorders
- Sex
- Genetic disorders
- Premature babies
- Rubella in mother
- Symptoms
- Diagnosis and examinations
- Treatment of heart disease
- Spontaneous closure
- Other congenital heart defects
- Medication, catheterization or surgery
- Prognosis of opening of ductus arteriosus
- Complications of congenital heart disease
Causes of non-closure of blood vessel
The ductus arteriosus is the blood vessel that allows blood to flow around the lungs of an unborn baby. The fetal blood vessel normally closes a few days after birth. With patent ductus arteriosus, these fetal blood vessels remain open. The heart defect therefore results in an irregular transfer of blood between the aorta and the pulmonary artery. Although the precise reasons why this happens in some patients and not in others are not known as of October 2020, some risk factors are known.
Risk factors of patent ductus arteriosus
Congenital heart disease
Patent ductus arteriosus is common in babies with congenital heart defects, such as hypoplastic (underdeveloped) left heart syndrome, transposition of the great blood vessels, and pulmonary stenosis (narrowing of the opening of the pulmonary valve), among others.
Chromosomal disorders
Babies with chromosal disorders, such as Down syndrome or Down syndrome, are also more likely to be affected by the heart defect.
Sex
Patent ductus arteriosus is also more common in girls than in boys.
Genetic disorders
Patent ductus arteriosus also occurs in certain congenital disorders, such as:
- the CHARGE syndrome
- the CHOPS syndrome (heart defects and respiratory problems)
- the Loeys-Dietz syndrome
- the Wiedemann-Steiner syndrome
Premature babies
The heart defect is more common in premature infants where the heart and lungs are underdeveloped, as well as in children with neonatal respiratory distress syndrome.
Rubella in mother
Babies whose mothers had rubella (a condition with a rash on the face, trunk, arms and legs) during pregnancy (congenital rubella syndrome) are also at a higher risk of developing patent ductus arteriosus.
Symptoms
A small patent ductus arteriosus may not cause any symptoms. However, some babies experience symptoms such as:
- breathing problems
- cardiomegaly (enlarged heart)
- differential cyanosis: blue discoloration of the lower extremities but not of the upper body.
- poor growth and weight gain
- rapid breathing
- a rapid pulse
- heavy breathing
- shortness of breath
- bad dietary habits
- tired quickly
- sweating while feeding
Diagnosis and examinations
Babies with patent ductus arteriosus often have a heart murmur that can be heard with a stethoscope (auscultation: listening test with stethoscope). However, in premature babies, a heart murmur may not be audible. The doctor suspects that the baby is suffering from the condition if he has difficulty breathing or feeding shortly after birth. An X-ray of the chest (chest X-ray) reveals typical changes. An echocardiography (examination of the heart using sound waves) confirms the diagnosis of the heart condition. Sometimes the doctor only diagnoses a small patent ductus arteriosus later in childhood.
Treatment of heart disease
Spontaneous closure
Sometimes a patent ductus arteriosus closes on its own. In premature babies, the opening often closes within the first two years of life.
Other congenital heart defects
If the baby has certain other congenital heart problems or defects, keeping the ductus arteriosus open is often life-saving. For example, during transposition of the large blood vessels, remaining open of the ducturs arteriosus is the only way in which oxygen-rich blood can mix with oxygen-poor blood. In these situations, the doctor uses prostaglandins to keep the ductus arteriosus open. NSAIDs (non-steroidal anti-inflammatory drugs) are then not indicated until surgical correction of the heart defect is completed.
Medication, catheterization or surgery
In full-term infants, a patent ductus arteriosus that remains open after the first few weeks rarely closes spontaneously. If the patient has no other heart defects, the doctor will want to close the opening at the patent ductus arteriosus. When treatment is needed, drugs such as indomethacin or ibuprofen are often the first choice. These medicines work very well for some newborns, with few side effects. The sooner the doctor starts treatment, the greater the chance of successful treatment. If these measures do not work or are ineffective, the baby may need a medical procedure. The doctor then places a kind of catheter (thin, hollow tube) in a blood vessel. Surgery is necessary if the cardiac catheterization does not work or it is not usable due to the size of the baby or for other reasons. The doctor then makes a small incision between the ribs to repair the patent ductus arteriosus.
Prognosis of opening of ductus arteriosus
The prognosis of patent ductus arteriosus is excellent in patients in whom this is the only problem. In premature infants who have other consequences of prematurity, the prognosis depends on the severity of the other problems. Patients usually experience no further symptoms after the closure of the open ductus arteriosus and no longer have any other heart complaints.
Complications of congenital heart disease
If a small patent ductus arteriosus remains open, the baby will eventually develop heart problems. Babies with a larger patent ductus arteriosus may then develop heart problems such as congestive heart failure, high blood pressure in the arteries of the lungs (pulmonary hypertension), Eisenmenger syndrome or an infection of the inner lining of the heart (endocarditis) if the patent ductus arteriosus does not close. Finally, premature babies with a significant patent ductus arteriosus are more likely to develop bronchopulmonary dysplasia (lung disease caused by ventilation).
read more
- Congenital Defects: Causes of Birth Defects
- Congenital heart defects (congenital heart disease) in babies
- Heart Health: Tips for a Healthy Heart & Heart Disease Prevention
- Cardiac rehabilitation: Rehabilitation program after heart problems