Patent ductus arteriosus (PDA) is a congenital heart defect wherein a neonate's ductus

arteriosus fails to close after birth. Symptoms are uncommon but in the first year of life include
increased work of breathing and poor weight gain. With age, the PDA may lead to congestive
heart failure if left uncorrected.

Etiology

A patent ductus arteriosus can be idiopathic (i.e. without an identifiable cause), or secondary to
another condition. Some common contributing factors in humans include: - Premature infants -
Congenital rubella syndrome - Chromosomal abnormalities such as Down Syndrome

Normal ductus arteriosus closure

In the developing fetus, the ductus arteriosus (DA) is the vascular connection between the
pulmonary artery and the aortic arch that allows most of the blood from the right ventricle to
bypass the fetus' fluid-filled compressed lungs. During fetal development, this shunt protects the
right ventricle from pumping against the high resistance in the lungs, which can lead to right
ventricular failure if the DA closes in-utero.

When the newborn takes its first breath, the lungs open and pulmonary vascular resistance
decreases. After birth, the lungs release bradykinin to constrict the smooth muscle wall of the
DA and reduce bloodflow through the DA as it narrows and completely closes, usually within
the first few weeks of life. In most newborns with a patent ductus arteriosus the blood flow is
reversed from that of in utero flow, ie. the blood flow is from the higher pressure aorta to the
now lower pressure pulmonary arteries.
In normal newborns, the DA is substantially closed within 12-24 hours after birth, and is
completely sealed after three weeks. The primary stimulus for the closure of the ductus is the
increase in neonatal blood oxygen content. Withdrawal from maternal circulating maternal
prostaglandins also contributes to ductal closure. The residual scar tissue from the fibrotic
remnants of DA, called the ligamentum arteriosum, remains in the normal adult heart.

Patent ductus arteriosus

Patent ductus arteriosus, or PDA, is a heart condition that is normal but reverses soon after birth.
In a persistent PDA, there is an irregular transmission of blood between two of the most
important arteries in close proximity to the heart. Although the ductus arteriosus normally seals
off within a few days, in PDA, the newborn's ductus arteriosus does not close but remains patent.
PDA is common in neonates with persistent respiratory problems such as hypoxia, and has a high
occurrence in premature children. In hypoxic newborns, too little oxygen reaches the lungs to
produce sufficient levels of bradykinin and subsequent closing of the DA. Premature children are
more likely to be hypoxic and thus have PDA because of their underdeveloped heart and lungs.

A patent ductus arteriosus allows that portion of the oxygenated blood from the left heart to flow
back to the lungs (following the pressure gradient from the higher pressure aorta to the
pulmonary arteries). If this shunt amount is substantial, the neonate becomes short of breath
because there is not only the normal amount of unoxygenated blood that has returned from the
body to go to the lungs but in addition there is the amount shunted through the PDA. The
neonate's work of breathing is increased, using up more calories and often interfering with
feeding in infancy. This condition as a constellation of findings is called congestive heart failure.

In some cases, such as in transposition of the great vessels (the pulmonary artery and the aorta), a
PDA may need to remain open. In this cardiovascular condition, the PDA is the only way that
oxygenated blood can mix with deoxygenated blood. In these cases, prostaglandins are used to
keep the patent ductus arteriosus open.

Prognosis

Without treatments, Disease may progress from left-to-right(noncyanotic heart) shunt to right-to-
left shunt(cyanotic heart) called Eisenmenger syndrome.

Signs and symptoms

While some cases of PDA are asymptomatic, common symptoms include:

• tachycardia or other arrhythmia

• respiratory problems
• shortness of breath
• continuous machine-like murmur
• enlarged heart
• Left subclavicular thrill
• Bounding pulse
 [1]
• Widened pulse pressure
• Poor growth [2]

Treatment

Neonates without adverse symptoms may simply be monitored as outpatients, while

symptomatic PDA can be treated with both surgical and non-surgical methods.[3] Surgically, the
DA may be closed by ligation, wherein the DA is manually tied shut, or with intravascular coils
or plugs that leads to formation of a thrombus in the DA. This was first performed in humans by
Robert E. Gross. Because Prostaglandin E-2 is responsible for keeping the ductus patent,
inhibitors of prostaglandin synthesis such as Indomethacin have been used to help close a PDA.
This is an especially viable alternative for premature infants.

In certain cases it may be beneficial to the neonate to prevent closure of the ductus arteriosus.
For example, in transposition of the great vessels, a PDA may prolong the newborn's life until
surgical correction is possible. The ductus arteriosus can be induced to remain open by
administering prostaglandin analogs such as alprostadil or misoprostol (prostaglandin E1
analogs).

More recently, PDAs can be closed by percutaneous interventional method. Via the femoral vein
or femoral artery, a platinum coil can be deployed via a catheter, which induces thrombosis (coil
embolization). Alternatively, a PDA occluder device (AGA Medical), composed of nitinol mesh,
is deployed from the pulmonary artery through the PDA. The larger skirt of the device sits on the
aortic side while the ampulla of the device hugs the walls of the PDA, with care taken to avoid
occlusion of the pulmonary arterial lumen by the device. These methods permit closure without
open heart surgery.

http://en.wikipedia.org/wiki/Patent_ductus_arteriosus

Patent ductus arteriosus (PDA) accounts for 5 to 10% of congenital heart anomalies;
the male:female ratio is 1:3. PDA is very common among premature infants (in 45%
with birth weight < 1750 g; in about 80% with birth weight < 1200 g). Significant
PDA causes heart failure (HF) in 15% of premature infants with birth weight < 1750
g and in 40 to 50% of those with birth weight < 1500 g

Treatment

In premature infants with compromised respiratory status, the PDA can sometimes be closed by
using a prostaglandin synthesis inhibitor (eg, indomethacin Some Trade Names
INDOCIN
Congenital Cardiovascular Anomalies: Indomethacin Dosing Guidelines (mg/kg) for doses] IV
q 12 h for 3 doses; or ibuprofen Some Trade Names
ADVIL
MOTRIN
NUPRIN
10 mg/kg po followed by 2 doses of 5 mg/kg at 24-h intervals) with or without fluid restriction.
If this treatment is ineffective, surgical ligation is indicated.

Table 4
Indomethacin Dosing Guidelines
(mg/kg)
Age At Dose 1 Dose 2 Dose 3
Dose 1
< 48 h 0.2 0.1 0.1
2–7 days 0.2 0.2 0.2
> 7 days 0.2 0.25 0.25

In full-term infants, indomethacin Some Trade Names

INDOCIN is usually ineffective. For a large PDA, surgical ligation and division are typically
done electively at age 6 mo to 3 yr. If HF develops, surgery can be done earlier after medical
management for HF. Nonsurgical options for PDA closure include various catheter-delivered
occlusion devices (percutaneous coil occlusion, Amplatzer duct occluder, Rashkind umbrella
device). These techniques have become the treatment of choice in children > 1 yr. Outcomes
after PDA closure are excellent.

Before and for 6 to 12 mo after surgical or catheter-based PDA closure, all patients require
endocarditis prophylaxis (see Table 4: Endocarditis: Recommended Endocarditis Prophylaxis
During Oral-Dental, Respiratory Tract, or Esophageal Procedures* ) before dental or surgical
procedures. Patients with a residual shunt require prophylaxis indefinitely.

http://www.merck.com/mmpe/sec19/ch287/ch287e.html

PATENT DUCTUS ARTERIOSUS (PDA)

The ductus arteriosus is a normal fetal structure, allowing

blood to bypass circulation to the lungs. Since the fetus
does not use his/her lungs (oxygen is provided through the
mother’s placenta), flow from the right ventricle needs an
outlet. The ductus provides this, shunting flow from the left
 pulmonary artery to the aorta just beyond the origin of the
artery to the left subclavian artery. The high levels of
oxygen which it is exposed to after birth causes it to close in
most cases within 24 hours. When it doesn’t close, it is
termed a Patent Ductus Arteriosus.

The defect often corrects itself within several months of

birth, but may require infusion of chemicals, the placement
of "plugs" via catheters, or surgical closure.

The flow pattern is similar to the septal defects noted

above, except that the shunting occurs outside of the heart.
The left ventricle has to pump blood out through the aorta,
only to have some of it flow to the lower pressure pulmonary
artery, and directly back to the left atrium and ventricle. If a
large PDA is not corrected, then the pressures in the
pulmonary arteries may become very high and induce
changes in the arteries themselves such that even closure of
the defect will no longer improve the patient. In this case,
the pressures in the right side of the heart are high enough
that blood may begin to flow from the right to the left side
of the heart. This situation is called "Eisenmenger’s
syndrome", a condition which may result from several
similar abnormalites.

http://www.heartpoint.com/congpda.html

Treatments and drugs

By Mayo Clinic staff

In a premature infant, the patent ductus arteriosus often closes on its own in the weeks after birth. In
a full-term infant, a patent ductus arteriosus usually will close within the first few days of life. If the
defect doesn't close and is causing health problems, medications or surgery may be used to close it.

Medications
Doctors use nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or indomethacin, to
help close a patent ductus arteriosus in premature infants. NSAIDs block the hormone-like chemicals
in the body that keep the PDA open.
Surgery
Surgery to repair a patent ductus arteriosus involves patching or sewing shut the abnormal opening.
This can be done through an incision in the side of the chest or by catheterization. In cardiac
catheterization, a thin tube (catheter) is inserted into a blood vessel in the groin and threaded up to
the heart. Through the catheter, a plug or coil may be deployed to close the ductus arteriosus. In
surgery, the ductus is closed with a metal clip.

Preventive antibiotics
In the past, it was recommended that people with an unrepaired patent ductus arteriosus take
antibiotics before dental work and certain types of surgical procedures to prevent infective
endocarditis.

But new guidelines issued by the American Heart Association in 2007 have substantially revised this
recommendation. After weighing the risks and benefits of preventive antibiotics, the reviewing
committee found that the risks outweighed the benefits for most people, except a small group at high
risk of serious complications of infectious endocarditis.

The reviewers found that random germs caused infectious endocarditis more frequently than did
routine dental or medical procedures. They suggest a more effective strategy for preventing
endocarditis may be to practice good oral hygiene and get regular dental checkups. They also noted
that taking preventive antibiotics carries certain uncommon though possible risks, such as an allergic
reaction, and may contribute to growing antibiotic resistance.

Because of these changes, preventive antibiotics are no longer recommended for many people with a
patent ductus arteriosus. However, some people still need antibiotics, such as those who:

 Have other heart conditions or artificial valves

 Have a large defect that's causing a low blood oxygen level

 Have had repair with prosthetic material

If you've been told you or your child needed to take antibiotics before any procedures in the past, talk
with your doctor about how these new recommendations apply to you.

http://www.mayoclinic.com/health/patent-ductus-
arteriosus/DS00631/DSECTION=treatments%2Dand%2Ddrugs

When PDA is suspected, a patient may undergo a series of tests such as:

• Echocardiogram. This test uses sound waves to visualize the structures and functions of
the heart. A moving image of the patient’s beating heart is displayed on a video screen,
where a physician can study the heart’s thickness, size and function. The image also
shows the motion pattern and structure of the four heart valves, revealing any potential
leakage (regurgitation) or narrowing (stenosis). During this test, a Doppler ultrasound
may be done to evaluate blood flow through the PDA. This is the definitive test in
diagnosing a PDA. It may also help in judging the significance of the defect and whether
there are any other associated malformations.
 • Chest x-ray. A radiation-based imaging test that offers the physician a picture of the
general size, shape, and structure of the heart and lungs. This test may show congestion
of the lungs because of increased fluid.

• Electrocardiogram (EKG). A recording of the heart's electrical activity as a graph on a

moving strip of paper or video monitor. The highly sensitive electrocardiograph machine
helps detect heart irregularities, disease and damage by measuring the heart's rhythms and
electrical impulses. This test is generally normal in the child with a PDA unless the defect
is so large that there is considerable, chronic overwork to the pulmonary blood vessels
and left ventricle.

Among premature infants, PDA can possibly be detected by such symptoms as troubled
breathing, abnormal heart rhythm and other symptoms of heart failure.

http://yourtotalhealth.ivillage.com/patent-ductus-arteriosus.html?pageNum=6

GENERIC NAME: indomethacin

BRAND NAME: Indocin, Indocin-SR

DRUG CLASS AND MECHANISM: Indomethacin is a nonsteroidal anti-inflammatory drug

(NSAID) that reduces fever, pain and inflammation. It is similar to ibuprofen (Motrin) and
naproxen (Naprosyn, Aleve). Indomethacin works by reducing the production of prostaglandins.
Prostaglandins are chemicals that the body produces to cause fever and pain that are associated
with inflammation. Indomethacin blocks the enzymes that make prostaglandins (cyclooxygenase
1 and 2) and thereby reduces the levels of prostaglandins. As a result, fever, pain and
inflammation are reduced. Indomethacin is available in a sustained (slow) release form (Indocin-
SR). The FDA first approved indomethacin in January 1965.

PRESCRIBED FOR: Indomethacin is used for the treatment of inflammation caused

by rheumatoid arthritis, ankylosing spondylitis, gouty arthritis, osteoarthritis, and
soft tissue injuries such as tendinitis and bursitis.

GENERIC NAME: ibuprofen

BRAND NAME: Advil, Children's Advil/Motrin, Medipren, Motrin, Nuprin,

PediaCare Fever etc.

DRUG CLASS AND MECHANISM: Ibuprofen belongs to a class of drugs called non-
steroidal anti-inflammatory drugs (NSAIDs). Other members of this class include aspirin,
naproxen (Aleve), indomethacin (Indocin), nabumetone (Relafen) and several others. These
drugs are used for the management of mild to moderate pain, fever, and inflammation. Pain,
fever, and inflammation are promoted by the release in the body of chemicals called
prostaglandins. Ibuprofen blocks the enzyme that makes prostaglandins (cyclooxygenase),
resulting in lower levels of prostaglandins. As a consequence, inflammation, pain and fever are
reduced. The FDA approved ibuprofen in 1974.

PRESCRIBED FOR: Ibuprofen is used for the treatment of mild to moderate pain,
inflammation and fever caused by many and diverse diseases.

USES: Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID), which relieves

pain and swelling (inflammation). It is used to treat headaches, muscle aches,
backaches, dental pain, menstrual cramps, arthritis, or athletic injuries. This
medication is also used to reduce fever and to relieve minor aches and pain due to
the common cold or flu. This drug works by blocking the enzyme in your body that
makes prostaglandins. Decreasing prostaglandins helps to reduce pain, swelling,
and fever.

http://www.medicinenet.com/ibuprofen-oral/article.htm

Pathophysiology
The murmur in patent ductus arteriosus is characterized as being systolic and diastolic with a
crescendo and decrescendo pattern, peaking at around the closure of the aortic valve (A2). Due to
the left-to-right shunting at the patent ductus arteriosus the pulmonary venous return will be
increased causing dilatation of the left atrium and stretching of the patent foramen ovale with
more left-to-right shunting at the atrial level worsening congestive heart failure. The patent
ductus arteriosus murmur is best heard over the second left intercostal space. Clicking noises
during the murmur gives the characteristic machinery quality of the patent ductus arteriosus
murmur.

Murmurs mimicking patent ductus arteriosus include AP window, venous hum, ruptured sinus of
Valsalva (aorta to RA, RV or LA shunts), coronary artery to ventricular cavity fistula and
tetralogy of Fallot with pulmonary atresia and large collaterals.

Patients present with congestive heart failure, this include easy fatigability (poor feeding in
infants), shortness of breath, pallor sweating and cool extremities with exertion. Signs include
bounding pulses, increase left ventricular apical impulse, thrill, continuous murmur and
pulmonary sounds consistent with pulmonary edema such as rales and wheezing.

http://pediatriccardiology.uchicago.edu/MP/CHD/PDA/PDA.htm

Prognosis

In premature babies with significant PDA there is risk of broncho-pulmonary dysplasia. If a child
with RDS is found to have PDA too this is an adverse prognostic sign.13 If a premature infant
does not have RDS or it is uncomplicated, the timing of spontaneous closure of the ductus is
normal.14 In most patients who have had successful closure of a PDA there are no further
complications.

http://www.patient.co.uk/doctor/Patent-Ductus-Arteriosus.html

RN interventions would be: assessment of vitals & signs such as tachycardia,

tachypnea, scalp diaphoresis (signs CHF), I/O and weight (weigh diapers, check fluid
retention), monitor for edema, position bed in semi-fowlers if necessary, avoid cold
stress in infant (always keep infants warm!), reduce environmental stimuli...rest!,
O2 if RX, organize RN actions to promote uninterrupted sleep (think about this when
entering room & infant is sleeping...what do you do first? Do things you don't need
to wake infant for in priority). administer RX, Instruct parents (don't forget CPR and
SDS teaching). Basically...the RN should activate all care usually associated with
CHF because anormal communicaiton between these larger arteries is going to
permit bloodflow from the left side of the heart (high pressure) to the right side (low
pressure). If you don't understand this, then you need to revise your cardiav
physiology!

http://wiki.answers.com/Q/Nursing_interventions_fo_patient_having_patent_ductus_a
rteriosus
Cardiovascular Disorders

Patent Ductus Arteriosus (PDA)

Click Image to Enlarge

What is a patent ductus arteriosus (PDA)?

PDA is a heart problem that is usually noted in the first few weeks or months after birth. It is
characterized by a connection between the aorta and the pulmonary artery which allows oxygen-
rich (red) blood that should go to the body to recirculate through the lungs.

All babies are born with this connection between the aorta and the pulmonary artery. While your
baby was developing in the uterus, it was not necessary for blood to circulate through the lungs
because oxygen was provided through the placenta. During pregnancy, a connection was
necessary to allow oxygen-rich (red) blood to bypass your baby's lungs and proceed into the
body. This normal connection that all babies have is called a ductus arteriosus.

At birth, the placenta is removed when the umbilical cord is cut. Your baby's lungs must now
provide oxygen to his/her body. As your baby takes the first breath, the blood vessels in the
lungs open up, and blood begins to flow through to pick up oxygen. At this point, the ductus
arteriosus is not needed to bypass the lungs. Under normal circumstances, within the first few
days or weeks after birth, the ductus arteriosus closes and blood no longer passes through it.
Most babies have a closed ductus arteriosus by 72 hours after birth.
Click Image to Enlarge

In some babies, however, the ductus arteriosus remains open (patent) and becomes a problem,
PDA. The opening between the aorta and the pulmonary artery allows oxygen-rich (red) blood to
pass back through the blood vessels in the lungs.

PDA is the sixth most common congenital heart defect, occurring in 6 to 11 percent of all
children with congenital heart disease. Patent ductus arteriosus occurs twice as often in girls as in
boys.

What causes patent ductus arteriosus?

In many children, there is no known reason for the ductus arteriosus remaining open. However,
PDA is seen more often in the following:

• premature infants
• infants born to a mother who had rubella during the first trimester of
pregnancy

Some congenital heart defects may have a genetic link, either occurring due to a defect in a gene,
a chromosome abnormality, or environmental exposure, causing heart problems to occur more
often in certain families. Most often, a PDA occurs sporadically (by chance), with no clear
reason for its development.

PDA can also occur in combination with other heart defects.

Why is PDA a concern?

When the ductus arteriosus stays open, oxygen-rich (red) blood passes from the aorta to the
pulmonary artery, mixing with the oxygen-poor (blue) blood already flowing to the lungs. The
blood vessels in the lungs have to handle a larger amount of blood than normal. How well the
lung vessels are able to adapt to the extra blood flow depends on how big the PDA is and how
much blood is able to pass through it from the aorta.
Extra blood causes higher pressure in the blood vessels in the lungs. The larger the volume of
blood that goes to the lungs, the higher the pressure. The lungs are able to cope with this extra
blood flow and pressure for a while, depending on exactly how high the pressure is. Without
medical treatment, however, the blood vessels in the lungs become diseased by the extra
pressure.

Further, because blood is pumped at high pressure through the PDA, the lining of the pulmonary
artery will become irritated and inflamed. Bacteria in the bloodstream can easily infect this
injured area, causing a serious illness known as bacterial endocarditis.

What are the symptoms of a patent ductus arteriosus?

The size of the connection between the aorta and the pulmonary artery will affect the type of
symptoms noted, the severity of symptoms, and the age at which they first occur. The larger the
opening, the greater the amount of blood that passes through that overloads the lungs.

A child with a small patent ductus arteriosus might not have any symptoms, and your child's
physician may have only noted the defect by hearing a heart murmur. Other infants with a larger
PDA may exhibit different symptoms. The following are the most common symptoms of PDA.
However, each child may experience symptoms differently. Symptoms may include:

• fatigue
• sweating
• rapid breathing
• heavy breathing
• congested breathing
• disinterest in feeding, or tiring while feeding
• poor weight gain

The symptoms of a PDA may resemble other medical conditions or heart problems. Always
consult your child's physician for a diagnosis.

How is a patent ductus arteriosus diagnosed?

Your child's physician may have heard a heart murmur during a physical examination, and
referred your child to a pediatric cardiologist for a diagnosis. A heart murmur is simply a noise
caused by the turbulence of blood flowing through the opening from the left side of the heart to
the right.

A pediatric cardiologist specializes in the diagnosis and medical management of congenital heart
defects, as well as heart problems that may develop later in childhood. The cardiologist will
perform a physical examination, listening to the heart and lungs, and make other observations
that help in the diagnosis. The location within the chest where the murmur is heard best, as well
as the loudness and quality of the murmur (harsh, blowing, etc.) will give the cardiologist an
initial idea of which heart problem your child may have. However, other tests are needed to help
with the diagnosis, and may include the following:
 • chest x-ray - a diagnostic test which uses invisible electromagnetic energy
beams to produce images of internal tissues, bones, and organs onto film.
With a PDA, the heart may be enlarged due to larger amounts of blood flow
through the lungs than normal. Also, there may be changes that take place in
the lungs due to extra blood flow that can be seen on an x-ray.
• electrocardiogram (ECG or EKG) - a test that records the electrical activity of
the heart, shows abnormal rhythms (arrhythmias or dysrhythmias), and
detects heart muscle stress.
• echocardiogram (echo) - a procedure that evaluates the structure and
function of the heart by using sound waves recorded on an electronic sensor
that produce a moving picture of the heart and heart valves. An echo can
show the pattern of blood flow through the PDA, and determine how large the
opening is, as well as how much blood is passing through it.
• cardiac catheterization - a cardiac catheterization is an invasive procedure
that gives very detailed information about the structures inside the heart.
Under sedation, a small, thin, flexible tube (catheter) is inserted into a blood
vessel in the groin, and guided to the inside of the heart. Blood pressure and
oxygen measurements are taken in the four chambers of the heart, as well as
the pulmonary artery and aorta. Contrast dye is also injected to more clearly
visualize the structures inside the heart.

The cardiac catheterization procedure may also be an option for treatment.

During the procedure, the child is sedated and a small, thin, flexible tube
(catheter) is inserted into a blood vessel in the groin and guided to the inside
of the heart. Once the catheter is in the heart, the cardiologist will pass a
special device, called a coil or occluder, into the open PDA preventing blood
from flowing through it.

Treatment for patent ductus arteriosus:

Specific treatment for PDA will be determined by your child's physician based on:

• your child's age, overall health, and medical history

• extent of the disease
• your child's tolerance for specific medications, procedures, or therapies
• expectations for the course of the disease
• your opinion or preference

A small patent ductus arteriosus may close spontaneously as your child grows. A PDA that
causes symptoms will require medical management, and possibly even surgical repair. Your
child's cardiologist will check periodically to see whether the PDA is closing on its own. If a
PDA does not close on its own, it will be repaired to prevent lung problems that will develop
from long-time exposure to extra blood flow. Treatment may include:

• medical management
In premature infants, an intravenous (IV) medication called indomethacin
may help close a patent ductus arteriosus. Indomethacin is related to aspirin
and ibuprofen and works by stimulating the muscles inside the PDA to
constrict, thereby closing the connection. Your child's physician can answer
 any further questions you may have about this treatment.

As previously mentioned, some children will have no symptoms, and require

no medications. However, others may need to take medications to help the
heart and lungs work better. Medications that may be prescribed include the
following:
o digoxin - a medicine that helps strengthen the heart muscle, enabling
it to pump more efficiently.
o diuretics - the body's water balance can be affected when the heart is
not working as well as it could. These medications help the kidneys
remove excess fluid from the body.
• adequate nutrition
Most infants with PDA eat and grow normally, but premature infants or those
infants with a large PDA may become tired when feeding, and are not able to
eat enough to gain weight. Options that can be used to ensure your baby will
have adequate nutrition include the following:
o high-calorie formula or breast milk
Special nutritional supplements may be added to formula or pumped
breast milk that increase the number of calories in each ounce,
thereby allowing your baby to drink less and still consume enough
calories to grow properly.
o supplemental tube feedings
Feedings given through a small, flexible tube that passes through the
nose, down the esophagus, and into the stomach, can either
supplement or take the place of bottle-feedings. Infants who can drink
part of their bottle, but not all, may be fed the remainder through the
feeding tube. Infants who are too tired to bottle-feed may receive their
formula or breast milk through the feeding tube alone.
• PDA repair or closure
The majority of infants and children with PDA are candidates for repair in the
cardiac cath lab. The goal is to repair the PDA before the lungs become
diseased from too much blood flow and pressure.

Repair is usually indicated in infants younger than 6 months of age who have
large defects that are causing symptoms, such as poor weight gain and rapid
breathing. For infants who do not exhibit symptoms, the repair may often be
delayed until after 6 months of age. Your child's cardiologist will recommend
when the repair should be performed.

Transcatheter coil closure of the PDA is frequently used because it is

minimally invasive. However, premature infants are not candidates for this
procedure.
Your child's PDA may be repaired surgically in the operating room. The
surgical repair, also called PDA ligation, is performed under general
anesthesia. The procedure involves closing the open PDA with stitches to
prevent the surplus blood from entering your child's lungs. Alternately, the
vessel connecting the aorta and pulmonary artery may be cut and cauterized
(sealed off by burning with an electrical instrument).

Post-procedure care for your child:

 • cath lab repair/closure procedure
When the procedure is complete, the catheter(s) will be withdrawn. Several
gauze pads and a large piece of medical tape will be placed on the site where
the catheter was inserted to prevent bleeding. In some cases, a small, flat
weight or sandbag may be used to help keep pressure on the catheterization
site and decrease the chance of bleeding. If blood vessels in the leg were
used, your child will be told to keep the leg straight for a few hours after the
procedure to minimize the chance of bleeding at the catheterization site.

Your child will be taken to a unit in the hospital where he/she will be
monitored by nursing staff for several hours after the test. The length of time
it takes for your child to wake up after the procedure will depend on the type
of medicine given to your child for relaxation prior to the test, and also on
your child's reaction to the medication.
After the procedure, your child's nurse will monitor the pulses and skin
temperature in the leg or arm that was used for the procedure.

Your child may be able to go home after a specified period of time, providing
he/she does not need further treatment or monitoring. You will receive
written instructions regarding care of the catheterization site, bathing,
activity restrictions, and any new medications your child may need to take at
home.
• surgical repair
Some children who undergo PDA ligation may need to spend some time in
the intensive care unit after surgery. Others may return to a regular hospital
room. Your child will be kept as comfortable as possible with medications
which relieve pain or anxiety. The staff will also be asking for your input as to
how best to soothe and comfort your child.

You will also learn how to care for your child at home before your child is
discharged. The staff will give you instructions regarding medications, activity
limitations, and follow-up appointments before your child is discharged. Most
children will only need to stay in the hospital for a few days after the
operation.

Care for your child at home following PDA repair:

Most infants and older children feel fairly comfortable when they go home. Pain medications,
such as acetaminophen or ibuprofen, may be recommended to keep your child comfortable. Your
child's physician will discuss pain control before your child is discharged from the hospital.

Often, infants who fed poorly prior to surgery have more energy after the recuperation period,
and begin to eat better and gain weight faster.

After surgery, older children usually have a fair tolerance for activity. Your child will usually be
allowed to play, while avoiding blows to the chest that might cause injury to the incision or
breastbone. Within a few weeks, your child should be fully recovered and able to participate in
normal activity.
You will receive additional instructions from your child's physicians and the hospital staff.

Long-term outlook after PDA surgical repair:

In premature infants, the outlook after PDA surgical repair depends on the following:

• your child's gestational age

• any other illnesses present in your baby

In children born full-term, most that had a patent ductus arteriosus diagnosed and repaired early
will live healthy lives after recovering from the hospitalization. Activity levels, appetite, and
growth should return to normal. Your child's cardiologist may recommend that antibiotics be
given to prevent bacterial endocarditis for a specific time period after discharge from the hospital
if the coil or occluder device was used.

In children whose PDA was diagnosed late and/or never repaired, the outlook is uncertain. There
is a risk for pulmonary hypertension (increased blood pressure in the blood vessels of the lungs).
These individuals should receive follow-up care at a center that specializes in congenital heart
disease.

Consult your child's physician regarding the specific outlook for your child.

Click here to view the

Online Resources of Cardiovascular Disorders

http://www.healthsystem.virginia.edu/uvahealth/peds_cardiac/pda.cfm