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When Your Child Has a Patent Ductus Arteriosus (PDA)

Front view cross section of heart showing patent ductus arteriosus connecting aorta and pulmonary artery. Arrows show blood flowing from left ventricle through aorta and some blood flowing through PDA to pulmonary artery.

Closeup of patent ductus arteriosus showing coil closing it off.

Your child has been diagnosed with a patent ductus arteriosus (PDA). The ductus arteriosus is a normal structure in a baby’s heart before birth. It’s a blood vessel that connects two arteries, the pulmonary artery and the aorta. The pulmonary artery carries blood from the heart to the lungs. The aorta carries blood from the heart to the body. The ductus arteriosus normally closes shortly after birth. It’s called a PDA when it stays open, or “patent.” A PDA can lead to worsening heart function over time, but it can be treated.

Why Is a PDA a Problem?

  • With a PDA, blood flows from the aorta through the PDA into the pulmonary artery. This causes increased blood flow to the lungs. If the PDA is large, too much blood goes to the lungs. This causes pulmonary edema (fluid buildup in  the lungs). Then the baby has a hard time breathing and feeding.

  • In severe cases, the combination of the increased blood flow to the lungs and work to the left ventricle can lead to congestive heart failure (CHF). This is a condition in which the heart no longer pumps blood well. 

  • Even with a small PDA (without too much blood flow to the lungs), the child is still at risk of infection of the lining of the heart and valves. This infection is called bacterial endocarditis.

What Are the Symptoms of a Patent Ductus Arteriosus?

Most children with a small PDA have no symptoms. Children with a large PDA are more likely to have symptoms. These can include:

  • Trouble breathing

  • Trouble feeding

  • Slow weight gain

  • Frequent respiratory infections

How Is a Patent Ductus Arteriosus Diagnosed?

Heart problems in children are usually diagnosed and treated by a doctor called a pediatric cardiologist. Signs of a heart problem will be checked for during a physical exam. To confirm a diagnosis or learn more about a possible heart problem, several tests may also be done. These include:

  • Chest x-ray: X-rays are used to take a picture of the heart and lungs.

  • Electrocardiography (ECG or EKG): The electrical activity of the heart is recorded.

  • Echocardiography: Sound waves are used to create a picture of the heart and look for structural defects and other problems.

How Is a Patent Ductus Arteriosus Treated?

A PDA may close on its own, without treatment. If it doesn’t, treatment options include cardiac catheterization or surgery. Your child’s cardiologist will evaluate your child’s heart and discuss the best treatment option with you.

  • Cardiac catheterization: A thin, flexible tube (catheter) is inserted into a blood vessel. It’s used to guide a coil or closing device into the heart to close the PDA. The catheter is removed when the coil or device is in place.

  • Surgery: With thoracotomy, an incision is made through the chest between the ribs to reach the PDA. Another technique, thoracoscopy, uses small incisions in the chest and a special scope that has a camera on the end to guide the surgeon to the PDA. The PDA is clipped or tied off. It may or may not be divided. If it’s divided, the open ends are closed with sutures.

Risks and Possible Complications of Surgery or Cardiac Catheterization:

  • Reaction to contrast dye (only with cardiac catheterization)

  • Reaction to sedative or anesthesia

  • Incomplete closure of the PDA

  • Infection

  • Bleeding

  • Arrhythmia (abnormal heart rhythm)

  • Injury to the heart or a blood vessel

When to Call the Doctor

After surgery or a cardiac catheterization procedure, call the doctor right away if your child has any of the following:

  • Increased redness, draining, swelling, or bleeding at the incision or insertion site

  • Fever 100.4°F or higher

  • Trouble feeding

  • Tiredness

  • Shortness of breath

  • Cough that won’t go away

  • Nausea or vomiting

  • Irregular heartbeat

What Are the Long-term Concerns?

  • After repair of a PDA, symptoms related to the defect should go away. Your child should have a heart that works normally.

  • Follow-up visits with the doctor may be needed for 6 months after treatment.

  • Your child may need to take antibiotics for about 6 months before having any surgery or dental work. This is to prevent infection of the inside lining of the heart or valves. This infection is called infective endocarditis. Antibiotics should be taken as directed by the cardiologist.

 

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