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Magill’s Medical Guide, 9th Edition

Patent ductus arteriosus

by Hunaina Shahab, , MD

Category: Disease/Disorder

Anatomy or system affected: Cardiovascular system, heart, aorta, pulmonary system, lungs, circulatory system, pulmonary artery, ligamentum arteriosum

Specialties and related fields: Cardiology, pediatrics, neonatology, pulmonology

Definition: A condition in which there is failure of the ductus arteriosus to close after birth, resulting in a persistent connection between the aorta and pulmonary arteries. This allows blood to flow from the aorta to the pulmonary arteries.

Key terms:

auscultation: listening to the sounds of the heart, lungs, and other internal organs, typically with a stethoscope

congenital: disease or abnormality that is present at the time of birth

echocardiogram: ultrasound that is used to visualize the structures of the heart

neonatalrespiratory distress: breathing disorder in newborns resulting from immature lungs that do not produce enough pulmonary surfactant

pulmonaryhypertension: high blood pressure in the blood vessels of the lungs

CAUSES AND SYMPTOMS

Patent ductus arteriosus (PDA) is a common congenital (at birth) heart defect with a prevalence of 1 in 2,000 births. Prior to birth, the fetus does not need blood to travel through the lungs for oxygenation. The developing fetus receives oxygen from the mother’s circulation through a vessel that connects the pulmonary artery to the descending aorta called the “ductus arteriosus.” Low oxygen saturation and high levels of a prostaglandin (PGE2) keep this ductus arteriosus patent, or open, to allow blood to bypass the fetus’s nonfunctioning lungs. Once the baby is born and takes its first breath, blood vessels in the lungs open, allowing blood to flow to the lungs to pick up oxygen. Usually within twenty-four to seventy-two hours after birth, the ductus arteriosus typically narrows and closes, due to high oxygen levels in the blood and low PGE2 levels and becomes the ligamentum arteriosum. PDA occurs when the ductus arteriosus does not close and allows the blood to circulate from the aorta into the pulmonary arteries causing a left-to-right shunt thereby sending oxygenated blood back to the lungs). This left to right shunting causes too much blood to flow into the infant’s lungs. This overtime leads to pulmonary hypertension (high blood pressure in the lungs), which can lead to congestive heart failure.

Information on Patent Ductus Arteriosus

Causes: Premature birth, congenital rubella syndrome, genetic conditions, chromosomal abnormalities, high-altitude birth

Symptoms: Tachypnea (rapid breathing), dyspnea (shortness of breath), continuous machine-like heart murmur, poor feeding, poor weight gain, fatigue, cyanosis, heart failure

Duration: The abnormality can present in the first year of life and last into adulthood depending on the size of the defect

Treatments: NSAIDS, Indomethacin, trans-catheter coil, open-heart surgery

Some infants are at a higher risk than others for developing PDA, but the exact etiology of the condition is unknown. PDA is more common in females than males, and it has been most commonly associated with premature birth, especially with neonatal respiratory distress syndrome. Neonatal respiratory distress syndrome is a breathing disorder common in premature infants caused by underdeveloped lungs. Maternal infection with Rubella (German measles) during pregnancy is also a significant risk factor for the development of PDA. Genetics and family history can be risk factors that predispose certain children to the condition. A family history of heart defects or genetic conditions, such as Down syndrome (Trisomy 21) increase the risk of PDA. In addition, environmental factors may play a role. For example, infants born at altitudes higher than 10,000 feet (3,048 meters) are at a higher risk of developing PDA than those born at lower altitudes. PDA is also common in infants with other congenital heart defects such as transposition of the great vessels or pulmonary stenosis. Other syndromes that are associated with patent ductus arteriosus includes Holt-Oram syndrome, DiGeorge’s syndrome, Noonan’s syndrome, CHARGE syndrome, etc.

The most common symptoms of PDA include rapid or heavy breathing; shortness of breath; sweating; fatigue; poor feeding; and poor weight gain and growth. These symptoms vary according to the size of the PDA and whether the infant was born prematurely or full-term.. Small-sized patent ductus arteriosus may have no symptoms and the doctors can usually detect it by auscultating (listening to internal body sounds) the infant’s heart with a stethoscope. A PDA will produce a characteristic heart murmur that is commonly described as a “continuous machine-like” murmur. Chest X-rays and echocardiograms (an ultrasound that tests the heart’s function) will reveal an enlarged heart and evidence of increased blood flow to the lungs and can visualize the blood flowing through the PDA. Moderate-sized PDAs can cause exercise intolerance and increase in the size of the left chambers of the heart. Large-sized PDAs can cause a large amount of blood to flow from the aorta into the pulmonary arteries. Excess blood flow to the lungs leads to pulmonary hypertension. Pumping against this increased pressure causes the right ventricle of the heart to hypertrophy (become thicker), leading to heart failure very soon after birth. Thickening of the right ventricle can cause Eisenmenger syndrome. In this condition, a left-to-right shunt becomes a right-to-left shunt (when deoxygenated blood is sent to the body instead of the lungs), leading to cyanosis (bluish discoloration of the skin due to reduced oxygen in the blood).

Signs of PDA include bounding pulses with a wide difference between the systolic and diastolic blood pressure, dynamic cardiac impulse on palpation (feeling for the heart beat on the patients’ chest during examination), a normal sounding first cardiac sound (S1) with a split-second heart sound (S2) with a loud pulmonic component of the second heart sound (P2). There is a continuous “machinery” murmur in the left upper chest heard via the stethoscope.

Women who have significant-sized PDA and become pregnant may face serious issues during pregnancy. They are at a higher risk for certain complications such as arrhythmia (abnormal heart rhythms), heart failure, and pulmonary hypertension.. Pregnancy is not allowed when there is a right to left shunt and Eisenmenger syndrome has developed.

TREATMENT AND THERAPY

Infants typically need medication to help close the PDA. Some medications include nonsteroidal anti-inflammatory drugs (NSAIDs) such as indomethacin. Indomethacin blocks the hormone Prostaglandin E2 and should be administered a few days after birth. If medications do not work, catheterization or surgery may be required.

If the PDA does not close with medications, it may require transcatheter coil closure. During the procedure, catheters (long thin tubes) are inserted into the femoral artery in the leg and guided to the PDA near the heart. A coil is then inserted through the catheter to plug up the PDA. Sometimes, open-heart surgery is needed to close the PDA. During surgery, known as a “PDA ligation,” the surgeon will open the chest to expose the PDA. The PDA is then either tied closed with sutures or clamped shut with metal clip.

After the PDA is closed, the patient usually does not have any other health complications or physical restrictions. The long-term prognosis for those with PDA is very good. No further medications or additional procedures generally are needed.

According to the American Heart Association/American College of Cardiology guidelines for adults with congenital heart disease, PDA presenting in adults should be closed when there is a left to right shunt and there is enlargement of the left-sided heart chambers and lower pulmonary pressures and pulmonary vessel resistance. Closure is not allowed when there is a right to left shunt, very high pulmonary pressures or very high pulmonary vessel resistance.

While a comprehensive prevention method does not exist, pregnant women can assume certain steps to ensure a healthy pregnancy that can help reduce the risks of PDA. Some of these include:

  • Avoiding smoking, drinking alcohol, and taking drugs

  • Alleviating stress

  • Maintaining a healthy diet

  • Exercising

  • Receiving appropriate and timely vaccinations

  • Women with heart defects, genetic conditions, or a family history of such conditions should consult a physician or genetic counselor prior to becoming pregnant.

  • Regular checkups with their doctors during pregnancy

The complications of PDA include development of pulmonary hypertension and Eisenmenger’s syndrome, congestive heart failure and infective endocarditis (infection of the inner lining of the heart).

See also: Cardiac catheterization; Congenital rubella syndrome; Eisenmenger syndrome; Murmurs, auscultation; NSAIDS; Trisomy 21.

For Further Information:

1 

Bernstein D. “Patent Ductus Arteriosus.” Nelson Textbook of Pediatrics, edited by R. M. Kleigman, B. Stanton, J. St. Geme, et al.,19th ed., 2011, www.mdconsult.com/books/page.do?eid?=?4-u1.0-B978-1-4377-0755-7.00420-6—sc0 025&isbn?=?978-1-4377-0755-7&uniqId?=?406511368-3 #4-u1.0-B978-1-4377-0755-7.00420-6—sc0025.

2 

Kim, Luke K., and Jeffrey C. Milliken. “Patent Ductus Arteriosus (PDA).” Medscape. 16 Sept. 2015, emedicine.medscape.com/article/891096-overview. Accessed 14 Feb. 2016.

3 

“Patent Ductus Arteriosus (PDA).” American Heart Association, 14 Feb. 2016, www.heart.org/HEARTORG/Conditions/CongenitalHeartDe fects/AboutCongenitalHeartDefects/Patent-Ductus-Arteriosus-PDA_UCM_307032_Article.jsp #.Vr3r3Pnyu70.

4 

“Patent Ductus Arteriosus (PDA).” Lucile Packard Children’s Hospital Stanford. Stanford Children’s Health, 30 Aug. 2017, www.stanfordchildrens.org/en/topic/default?id=patent-ductus-arteriosus-pda-90-P01811. Accessed 4 Sept. 2017.

5 

“Patent Ductus Arteriosus (PDA).” Mayo Clinic. Mayo Foundation for Medical Education and Research, 16 Dec. 2014, www.mayoclinic.org/diseases-conditions/patent-ductus-arteriosus/basics/definition/con-20028530. Accessed 14 Feb. 2016.

6 

“Patent Ductus Arteriosus.” MedlinePlus, 14 Feb. 2016, www.nlm.nih.gov/medline plus/ency/article/001560.htm.

7 

Schneider, D. J., and J. W. Moore. “Patent Ductus Arteriosus.” Circulation, vol. 114, 2006, pp. 1873-82.

8 

Stout, K. K., C. J. Daniels, J. A. Aboulhosn, et al. “AHA/ACC Guideline for the Management of Adults with Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.” Journal of the American College of Cardiology, vol. 73, no. 12, 25 Mar. 2019, pp. e81-92.

9 

“What Is Respiratory Distress Syndrome?” National Heart, Lung, and Blood Institute. US Department of Health and Human Services, www.nhlbi.nih.gov/health/health-topics/topics/rds. Accessed 14 Feb. 2016.

Citation Types

Type
Format
MLA 9th
Shahab, Hunaina. "Patent Ductus Arteriosus." Magill’s Medical Guide, 9th Edition, edited by Anubhav Agarwal,, Salem Press, 2022. Salem Online, online.salempress.com/articleDetails.do?articleName=MMG2022_1031.
APA 7th
Shahab, H. (2022). Patent ductus arteriosus. In A. Agarwal, (Ed.), Magill’s Medical Guide, 9th Edition. Salem Press. online.salempress.com.
CMOS 17th
Shahab, Hunaina. "Patent Ductus Arteriosus." Edited by Anubhav Agarwal,. Magill’s Medical Guide, 9th Edition. Hackensack: Salem Press, 2022. Accessed October 22, 2025. online.salempress.com.