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Patent Ductus Arteriosus (PDA)

Patent Ductus Arteriosus: What it is, Risk Factors, Diagnosis, Treatments | National Heart Centre Singapore

Patent Ductus Arteriosus (PDA) - What it is

​The ductus arteriosus is present in all fetuses allowing blood to bypass the non-functioning lungs. At birth or shortly after birth as the baby starts to breathe, the ductus arteriosus would normally close permanently. Failure to do so results in patent ductus arteriosus (PDA) which is an open channel allowing blood to flow from the aorta (blood vessel carrying blood from the heart to the rest of the body) to the pulmonary artery (blood vessel supplying the lung). If the PDA is large, the heart will be volume-loaded resulting in heart failure. The PDA also carries a risk of bacterial infection (infective endarteritis). PDA can be closed by inserting a device through the blood vessels in the groin (percutaneous transcatheter approach).

Patent Ductus Arteriosus (PDA) - Symptoms

Patent Ductus Arteriosus (PDA) - How to prevent?

Patent Ductus Arteriosus (PDA) - Causes and Risk Factors

Risk factors


Activities 

Activity restrictions are unnecessary unless there are associated problems that you and your cardiologist have discussed. However, after PDA device closure, patients will be advised to refrain from strenuous activity and heavy lifting for at least 6 months. 

Prevention of endarteritis

Antibiotic prophylaxis prior to dental or other surgical procedures is no longer recommended for patients with patent PDA to prevent endarteritis (infection of arteries). After PDA device closure or surgical ligation, antibiotic prophylaxis is still required up to 6 months depending on whether the defect has completely closed.

Pregnancy and family planning

Women with small PDA are able to carry through their pregnancy well. However, it is still important to discuss any concerns on pregnancy with the cardiologist. 

Patent Ductus Arteriosus (PDA) - Diagnosis

Diagnosis normally starts with a physical examination by a doctor, assessing your medical history and routine tests. Other tests recommended may include:

Patent Ductus Arteriosus (PDA) - Treatments

The defect can be closed by a device (see Device Closure for PDA) or surgical ligation depending on the size of the defect and the presence of pulmonary hypertension. Even after the defect is closed, the patient may need regular follow-up with a cardiologist.

Device Closure for Patent Ductus Arteriosus (PDA)

The ductus arteriosus is present in all fetuses allowing blood to bypass the non-functioning lungs. At birth or shortly after birth as the baby starts to breathe, the ductus arteriosus would normally close permanently. Failure to do so results in patent ductus arteriosus (PDA) which is an open channel allowing blood to flow from the aorta (blood vessel carrying blood from the heart to the rest of the body) to the pulmonary artery (blood vessel supplying the lung). If the PDA is large, the heart will be volume-loaded resulting in heart failure. The PDA also carries a risk of bacterial infection (infective endarteritis). PDA can be closed by inserting a device through the blood vessels in the groin (percutaneous transcatheter approach).

Patent Ductus Arteriosus (PDA) - Preparing for surgery

During the test

This procedure is performed under local anaesthetic (LA) in the cardiac catheterisation lab. A plastic catheter (a long tube) will be inserted via a vein in the groin and navigated until it reaches the heart. Depending on the case, the catheter may be positioned at different chambers of your heart to measure the pressure and oxygen content prior to device closure. In certain circumstances, balloon sizing of the PDA may be required. Once your doctor is satisfied with all the measurements, the appropriate size device is connected onto a cable, put into a special delivery tube, advanced through your PDA and carefully deployed. Your doctor will study the device’s position and stability before releasing the device. The catheter will be removed and the procedure is completed. 


The procedure usually takes between 1 and 2 hours and the success rate is about 95%. 

Risks

However, there are known risks involved. The risks and their estimated incidence of occurrence are:

  • Device dislodgement (embolisation) and the need for emergency heart surgery: <1%
  • Death: <1% (usually from perforation of the heart chamber).
  • Dislodgement of clot or air bubbles to the brain (causing stroke) and other organs: <1% 
  • Rhythm disturbance (arrhythmia) (usually transient): <1%
  • Device distorting blood flow in the pulmonary artery: <1%
  • Other potential risks: Allergic dye reaction, anaesthetic reaction, bleeding and bruising around the sheaths in the groin, injury to the artery/vein/nerves in the groin, infection, fever, headache, migraine, allergic reaction to the nickel component of the device 


Some of these complications if they occur, are of a serious nature and may require further treatment including surgery and prolonged hospitalisation. In the event of device dislodgement, you may require surgery for removal of the device and ligation of the PDA at the same time.

This procedure is suitable for adults with PDA and heart enlargement or elevated pressure in the lung (as long as pressure is not irreversibly elevated). In adults, a device rather than coils is used as the defect is usually > 4mm in size. If the lung pressure is already very high, careful measurement of the lung pressure and lung resistance need to be performed first to determine if it is still safe to close such a defect.

Patent Ductus Arteriosus (PDA) - Post-surgery care

Patent Ductus Arteriosus (PDA) - Other Information

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