Definition:

A patent ductus arteriosus (PDA) is a congenital condition where the ductus does not close after birth.  The ductus is a small vessel connecting the aorta to the pulmonary artery.  Normally, a fetus uses the patent ductus to supply oxygenated blood from the mother to the body.  After birth, blood circulation through the pulmonary vessels in the lungs causes the ductus to close.  If it does not close, then there is more strain on the left ventricle, which can lead to pulmonary hypertension.  The closure of the ductus arteriosus relies on prostaglandin release locally after birth.  Patients can present with heart failure as early as their first year of life to routine finding to pulmonary hypertension.

Symptoms:

• Dyspnea (shortness of breath)
• Fatigue
• Palpitations
• Full, bounding pulses
• Cyanosis

Diagnosis:

• Physical exam - continuous heart murmur heard on stethoscope
• Chest X-Ray - to see if enlarged heart present, may see calcified PDA in adults
• Echocardiography - shows abnormal blood flow from aorta to pulmonary artery
• Cardiac catheterization - to directly visualize PDA invasively

Treatment:

• Indomethacin - can be given to infants with symptomatic simple PDA
• Surgery - ligation of ductus arteriosus IF
  • Premature infants with severe pulmonary problems
  • Infants with heart failure in 1st year of life
  • Asymptomatic children with PDA >2-3yrs old
  • Shunt flow >2:1