What is patent ductus arteriosus?
Patent ductus arteriosus is a congenital heart condition where there is a persistent connection between the pulmonary artery and the aorta. This causes blood to mix between the two arteries and forces the heart and lungs to work harder.
Patent ductus is the sixth most common congenital heart defect. It occurs in 5 to 10 percent of all children born with congenital heart disease. Patent ductus occurs twice as often in girls as in boys.
Almost all babies are born with a small connection between the pulmonary artery and aorta, called the ductus arteriosus. During pregnancy, this opening is necessary to allow oxygen-rich (red) blood to bypass the baby's lungs and flow into the body. In most cases, the ductus arteriosus closes naturally after birth.
In babies with patent ductus, the ductus arteriosus remains open (patent). This allows the oxygen-rich (red) blood to mix with oxygen-poor (blue) blood and forces the lungs and heart to handle a larger amount of blood than is normal.
How well the lung vessels can compensate depends on how big the patent ductus is and how much blood from the aorta is able to pass through it. Extra blood flow may cause in higher pressure in the blood vessels of the lungs, a condition called pulmonary hypertension. The larger the volume of blood that goes to the lungs, the more potential damage to the lungs and heart.
Also, because blood is pumped at high pressure through the patent ductus, the lining of the pulmonary artery may become irritated and inflamed. Bacteria in the bloodstream can easily infect this injured area, causing a serious illness known as bacterial endocarditis.
The extra blood that flows to the lungs through the patent ductus increases the workload of the heart and can lead to heart failure.
Patent Ductus Arteriosus | Symptoms & Causes
What are the symptoms of patent ductus arteriosus?
The size of the patent ductus arteriosus will affect the type of symptoms, the severity of symptoms and when they occur.
A child with a small patent ductus might not have any symptoms, and your child's doctor may only discover the defect by hearing a heart murmur.
Babies with a larger patent ductus may have the following symptoms:
- Fatigue
- Sweating
- Rapid breathing
- Heavy breathing
- Congested breathing
- Disinterest in feeding or tiring while feeding
- Poor weight gain
What are the causes of patent ductus arteriosus?
Almost all children have a small connection between the aorta and pulmonary artery at birth. It is not known why some children have a connection that doesn’t close.
Patent Ductus Arteriosus | Diagnosis & Treatments
How is patent ductus arteriosus diagnosed?
Patent ductus arteriosis is often first detected when your doctor hears an abnormal heart sound or heart murmur when listening to your baby’s heart.
Depending on the type of murmur your doctor hears, he or she may order further testing such as:
How is patent ductus arteriosus treated?
A small patent ductus arteriosus may close on its own as your child grows. For infants with a large patent ductus arteriosus who do not have any symptoms, the repair may be delayed until the child is bigger. If your child has a patent ductus arteriosus that causes symptoms (like difficulty breathing or difficulty gaining weight appropriately) or that strains the heart, a cardiologist will check periodically to see whether the patent ductus is closing on its own. If it remains open, it can be actively closed with a medicine or procedure.
Medication
The goal is to close the patent ductus arteriosus before the lungs become damaged from too much blood flow. In premature infants, medications may help close the patent ductus. These medications include indomethacin, ibuprofen, Tylenol, each working by stimulating the muscles inside the patent ductus arteriosus to tighten, closing the connection. Your child's physician can answer any questions you may have about this treatment.
Catheter-based closure
In many cases your child's patent ductus arteriosus may be repaired by a cardiac catheterization procedure. During cardiac catheterization, your child is sedated and a small, thin, flexible tube (catheter) is inserted into a blood vessel in the groin and guided through the inside of the heart into the patent ductus arteriosus. Once the catheter is in the patent ductus arteriosus, the cardiologist will use this catheter to place a special device, called an occluder, which is designed to completely seal the ductus, preventing blood from flowing through it.
Recently, a new transcatheter device was approved by the FDA to close a patent ductus arteriosus in extremely low birth weight newborns, making it possible for many more patients to benefit from this minimally invasive procedure.
Surgical repair
Surgical repair (ligation) is recommended for children for whom a catheter-based procedure is not an option. Your child's cardiologist will recommend when a transcatheter device or surgical repair should be performed.
The ligation procedure is performed under general anesthesia. The procedure involves making an incision in the skin and chest wall to reach the patent ductus arteriosus, and then closing the ductus from the outside with a clip or suture.
What is the long-term outlook for patent ductus arteriosus?
Most children with a patent ductus will live healthy lives after recovering from the repair. Their activity levels, appetite, and growth should return to normal.
How we care for patent ductus arteriosus
Our approach to the treatment of patent ductus at the Boston Children's Hospital Benderson Family Heart Center is a carefully coordinated approach by multiple specialties. We offer treatments, including medical therapy, minimally invasive catheter-based interventions, and minimally invasive surgical solutions.
Patent Ductus Arteriosus | Research & Innovation
Our areas of innovation for patent ductus arteriosus
Boston Children's is home to the nation's most intensive clinical and basic research program focused on pediatric heart disease. A world leader in opening new avenues of "translational research," our research team is focused on bringing laboratory advances to patients as quickly as possible.
Boston Children's has pioneered interventional catheterization repair of many types of congenital heart defects, including patent ductus arteriosus. In many cases, this eliminates the need for open-heart surgery, allowing less pain, reduced chance of infection, and shorter recovery time.
