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Children’s heart conditions can’t be prevented, but a lot can be done to improve and often completely repair their hearts at any age. Thanks to advanced technology and the pediatric heart experts at the Nemours Cardiac Center (based at Nemours/Alfred I. duPont Hospital for Children), most children born with a heart problem — even newborns only hours or days old — can be quickly diagnosed and treated right when it matters the most. At the Cardiac Center, we specialize in early detection and repair of congenital heart defects (also often called, “congenital heart disease”).
If your child’s been diagnosed with patent ductus arteriosus (or, “PDA”, for short), we’re here to ease your concerns, answer your questions, and give your child the best possible chance for a healthy future.
The ductus arteriosus is a normal connection formed in utero (in the womb during pregnancy) between the pulmonary artery (the large artery that receives blood from the right ventricle and carries it to the lungs) and the aorta (the blood vessel that delivers oxygen-rich blood from the left ventricle, the lower left-hand chamber of the heart, to the body). During pregnancy, the baby receives oxygenated blood from the mother through the placenta. The ductus arteriosus allows most of the oxygenated blood to bypass the lungs by flowing directly from the pulmonary artery to the aorta. After the baby is born and begins breathing, there are usually hormonal changes that cause the ductus arteriosus to close in the first few hours or days after birth.
When the ductus arteriosus does not close as it usually should, it’s called a “patent ductus arteriosus” (PDA) (“patent” is a Latin word meaning “open”). If the ductus remains open, the direction of blood flow usually reverses after birth, when the lungs inflate and the resistance to blood flow through the lungs drops. Oxygen-rich “red” blood then flows into the pulmonary arteries and lungs, causing varying degrees of excessive blood flow to the lungs.
If left open, this extra blood flow to the lung may result in two problems:
- heart failure. Heart failure occurs because the “red” blood going to the lungs is being pumped in a circle (from the lungs to the heart to the aorta, back through the PDA to the pulmonary artery and the lungs again) without ever reaching the body to drop off its oxygen. This is extra work for the heart and, in certain cases, it may be so much work that the heart begins to fail.
- high blood pressure in the lungs (also called “pulmonary hypertension”).
Over time (months to years depending on the size of the ductus arteriosus) the lungs respond to the extra blood flowing through the PDA by increasing the resistance to blood flow. This decreases the blood flow (and reduces the risk of heart failure), but can cause a permanent increase in the blood pressure in the lungs.
The amount of extra blood flow to the lungs is mostly determined by the size of the PDA — so small PDAs are unlikely to ever cause these problems. But we also know that when left alone, the abnormal blood flow through the PDA increases the risk of developing an infection at the location of the turbulence in the artery (this is called “endarteritis”).
How Does the Heart Normally Work?
When your child has a congenital heart defect, there’s usually something wrong with the structure of the heart. In order to understand your child’s condition, it can help to know how the heart should work normally.
Learn More About Normal Cardiac Anatomy »
Nemours’ experts at KidsHealth.org also offer these helpful resources to help both you and your child understand how the heart works:
Most commonly, PDAs are found in premature babies in the neonatal intensive care unit (NICU) because, in babies born early, the ductus arteriosus may not close. Occasionally, PDAs are identified in older children. In all ages, the diagnosis is usually suspected based on a caregiver hearing a heart murmur.
To confirm the diagnosis, we can perform an echocardiogram (or “echo”) at the Nemours Cardiac Center. An echo is a completely safe and painless test that uses ultrasound (sound waves) to build a series of pictures of the heart.
In premature babies, medicines may be used to close a patent ductus arteriosus (PDA), but they aren’t always effective so children may require surgery. Surgery (which is often done in the neonatal intensive care unit) involves placing a small metal clip across the ductus. Once the blood flow is blocked, the ductus shrinks down as it should.
Off-Site Patent Ductus Arteriosus (PDA) Procedures for Infants
If transporting a baby to duPont Hospital for Children would be risky, our Nemours Cardiac Center heart surgeons often perform this surgery at other hospitals in the region. A team (including the anesthesiologist, operating room nurses and a pediatric cardiac surgeon) travels to outlying hospital with all of the operating equipment yesterday to safely and rapidly treat infants in a neonatal intensive care unit (NICU) close to home with a procedure called a “PDA ligation.” Among the hospitals where we currently provide off-site PDA ligation are:
- Thomas Jefferson University Hospital (Philadelphia)
- Christiana Hospital (Newark)
- Main Line Health (Pennsylvania)
- Cooper University Hospital (New Jersey)
Treatment in Older Children
Although older children may get surgery, larger infants and children can commonly have the patent ductus arteriosus (PDA) closed during a cardiac catheterization procedure. The catheter technique involves closure with a synthetic device that plugs the PDA. Our cardiac catheterization specialist introduces the device through a heart catheter (a thin plastic, flexible tube that’s passed through a vein in the leg that leads up to the heart). Initially, the device is held in place by the pressure within the aorta and pulmonary artery. Over time, however, the device acts as a framework over which blood vessel tissue grows.
Most children do well following repair or closure of a patent ductus arteriosus (PDA). No additional surgical procedures are usually required.
If your child has patent ductus arteriosus (PDA), know that at the Nemours Cardiac Center we’re here to give your child the very best, most comprehensive and compassionate care. Our goal is to guide your family, from start to finish, through your child’s heart defect journey — and to help your child live the healthiest, most fulfilling life possible.
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Information for Patients
Outpatient Services and Inpatient Units: (302) 651-6660
After 5 p.m. and Weekends:
Cardiac Intensive Care Unit: (302) 651-6644
General Inpatient Unit, 2B: (302) 651-6690