Patent ductus arteriosus

The strategy for treating patent ductus arteriosus (PDA) depends largely upon the size of the opening. A small PDA often closes spontaneously as the child matures. PDAs that persist may increase the risk of developing endocarditis, cause excess blood flow to the lungs, and lead to heart failure. If the duct remains open and the heart does not respond to medical treatment, closure of the duct using either a transcatheter procedure or surgery may be necessary. Once the duct has closed, no further problems are typically encountered.

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Medical management may include administering indomethacin, a nonsteroidal anti-inflammatory drug, to newborns and infants to help constrict the muscle in the wall of the patent ductus arteriosus and close it. Digoxin may be used to strengthen the heart muscle and improve the efficiency of the heart and lungs. Diuretics also may be prescribed to help the body remove excess fluids.If medication is not successful or closure of the defect is deemed necessary, a transcatheter may be used to plug the opening and stop blood flow through the PDA. A transcatheter is a long, thin tube that is inserted into the body, usually in the groin area, and is guided through an artery to the defect, much like heart catheterization. A tiny device on the tip of the transcatheter, called an intravascular coil or occluder, is used to place plugs or coils to block the patent ductus arteriosus. This method is often used to treat small PDAs that do not close spontaneously.

Alternatively, surgeons can use ligation, a technique that may be used to close the patent ductus arteriosus by tying or clipping it together without opening the heart. The goal of PDA ligation is to prevent the lungs from becoming diseased from too much blood flow and prevent the development of heart failure. The procedure is performed with the infant under general anesthesia. An incision is made on the left side of the chest near the armpit, through which the PDA is exposed where it attaches to the aorta. The tie or clip is placed on the PDA and the flow across the PDA stops immediately. If the infant has no symptoms, the operation can be postponed until 6 months to 3 years of age.