The ductus arteriosus is a normal connection in utero between the pulmonary artery and the aorta. Since the lungs are still developing, the baby receives oxygenated blood from the mother during pregnancy. The ductus arteriosus allows the greater part of the oxygenated blood to bypass the non-aerated lungs by flowing directly from the pulmonary artery to the aorta. After the baby is born and begins breathing, hormonal changes occur causing the ductus arteriosus to close. A patent ductus arteriosus, or PDA, is when this connection does not close as it normally should. If the ductus remains open, the direction of flow reverses and some of the oxygen-rich blood from the aorta flows to the pulmonary artery and into the lungs. This may cause an excessive amount of blood flow to the lungs.
There are two reasons that necessitate the closure of a PDA. The first is the size of the ductus, which in turn determines the volume of extra blood being directed to the lungs. A large volume overload may result in enlargement of the heart and over time heart failure. The second reason is to avoid the risk of developing an infection in the heart known as endocarditis. Approximately, one-eighth of patients with a PDA will develop endocarditis. This increases mortality by 50% whereas the risk of surgery is almost zero.
Depending on the size of the ductus, a PDA may be treated in one of two ways. If the ductus is large, the child may require surgery that involves closing off the ductus with a clamp or suture. However, in many cases, the PDA can be closed using a spring coil or a synthetic plug. Both devices are introduced through a heart catheter, which is passed through a vein in the leg that leads up to the heart.
How Does Patent Ductus Arteriosus (PDA) Differ From Normal Cardiac Anatomy?
If your child has patent ductus arteriosus (PDA) or another congenital heart defect, there's usually something wrong with the structure of his or her heart.
Heart with Normal Cardiac Anatomy
When your child has a congenital heart defect, there's usually something wrong with the structure of his or her heart's structure.
The heart is composed of four chambers. The two upper chambers, known as atria, collect blood as it flows back to the heart. The two lower chambers, known as ventricles, pump blood with each heartbeat to the two main arteries (the pulmonary artery and the aorta). The septum is the wall that divides the heart into right and left sides. The atrial septum separates the right and left atria; likewise, the ventricular septum separates the two ventricles.
There are four valves that control the flow of blood through the heart. These flap-like structures allow blood to flow in only one direction. The tricuspid and mitral valves, also known as the atrioventricular valves, separate the upper and lower chambers of the heart. The aortic and pulmonary valves, also known as the arterial valves, separate the ventricles from the main arteries. Oxygen-depleted blood returns from the body and drains into the right atrium via the superior and inferior vena cavas. The blood in the right atrium then passes through the tricuspid valve and enters the right ventricle.
Next, the blood passes through the pulmonary valve, enters the pulmonary artery, and travels to the lungs where it is replenished with oxygen. The oxygen-rich blood returns to the heart via the pulmonary veins, draining into the left atrium. The blood in the left atrium passes through the bicuspid, or mitral, valve and enters the left ventricle.
Finally, the oxygen-rich blood flows through the aortic valve into the aorta and out to the rest of the body.
From Nemours' KidsHealth
- ECG (Electrocardiogram)
- Cardiac Catheterization
- When Your Child Needs a Heart Transplant
- If Your Child Has a Heart Defect
- Heart and Circulatory System
- Congenital Heart Defects Special Needs Factsheet
- Atrial Septal Defect
- A to Z: Tetralogy of Fallot
- A to Z: Atrial Flutter
- Patent Ductus Arteriosus (PDA)
- Ventricular Septal Defect
- Tetralogy of Fallot
- A to Z: Patent Ductus Arteriosus (PDA)
- A to Z: Hypoplastic Left Heart Syndrome
- Heart Murmurs
- Coarctation of the Aorta
- Congenital Heart Defects
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What Are Heart Murmurs?
The human heartbeat is usually steady: lub-dub, lub-dub. In some people, though, the blood makes an extra noise as it flows through the heart. This sound is called a murmur.
Doctors hear a heart murmur as a whooshing sound between heartbeats. The whoosh is just an extra noise that the blood makes as it flows through the heart.
What Happens in a Heart Murmur?
Depending on a person's age, the heart beats about 60 to 120 times every minute. Each heartbeat is really two separate sounds. The heart goes "lub" with the closing of the valves that control blood flow from the upper chambers to the lower chambers. Then, as the valves controlling blood going out of the heart close, the heart goes "dub."
A heart murmur describes an extra sound heard in addition to the "lub-dub." Sometimes these extra sounds are simply the sound of normal blood flow moving through a normal heart. Other times, a murmur may be a sign of a heart problem.
Who Gets Heart Murmurs?
Parents might worry if they're told that their child has a heart murmur. But heart murmurs are very common, and many kids are found to have one at some point. Most murmurs are not a cause for concern and won't affect a child's health at all.
How Are Heart Murmurs Diagnosed?
Doctors listen to the heart by putting a stethoscope on different areas of the chest. It helps if kids are quiet as the doctor listens, because some heart murmurs are very soft. It's not unusual for a murmur to be noticed during a routine checkup, even if none was heard before.
Heart murmurs are rated on a scale from 1 to 6 based on how loud they are. Grade 1 is very soft, whereas grade 6 is very loud. If a murmur is found, the doctor may refer a child to a pediatric cardiologist for further evaluation.
What Causes Heart Murmurs?
Innocent Heart Murmurs
The most common type of heart murmur is called functional or innocent. An innocent heart murmur is the sound of blood moving through a normal, healthy heart in a normal way. Just as you might hear air moving through an air duct or water flowing through a pipe, doctors can hear blood moving through the heart even when there's no heart problem.
An innocent heart murmur can come and go throughout childhood. Kids with these murmurs don't need a special diet, restriction of activities, or any other special treatment. Those old enough to understand that they have a heart murmur should be reassured that they aren't any different from other kids.
Most innocent murmurs will go away on their own as a child gets older.
Congenital Heart Defects
Some murmurs can indicate a problem with the heart. In these cases, doctors will have a child see a pediatric cardiologist. The cardiologist will order tests such as:
- a chest X-ray: a picture of the heart and surrounding organs
- an EKG: a record of the heart's electrical activity
- an echocardiogram: a picture of the heart made using sound waves
About 1 out of every 100 babies is born with a structural heart problem, or congenital heart defect. These babies may show signs of the defect as early as the first few days of life or not until later in childhood. Some kids won't have any symptoms beyond a heart murmur, while others will such signs as:
- rapid breathing
- difficulty feeding
- blueness in the lips (called cyanosis)
- failure to thrive
An older child or teen might:
- be very tired
- have trouble exercising or doing physical activity
- have chest pain
Call your doctor if your child has any of these symptoms.
Pregnant women have a higher risk of having a baby with a heart defect if they get rubella (German measles), have poorly controlled diabetes, or have PKU (phenylketonuria, a genetic error of the body's metabolism).
Common Heart Defects
Several kinds of heart problems can cause heart murmurs, including:
- Septal defects, which involve the walls (or septum) between the upper or lower chambers of the heart. A hole in the septum can let blood flow through it into the heart's other chambers. This extra blood flow may cause a murmur. It can also make the heart work too hard or become enlarged. Bigger holes can cause symptoms besides a heart murmur; smaller ones may eventually close on their own.
- Valve abnormalities, caused by heart valves that are narrow, too small, too thick, or otherwise abnormal. These valves don't allow smooth blood flow across them. Sometimes, they can allow backflow of blood within the heart. Either problem will cause a murmur. Outflow tract obstruction might be caused by extra tissue or heart muscle that blocks the smooth flow of blood through the heart.
- Heart muscle disorders (cardiomyopathy), which can make the heart muscle abnormally thick or weak, hurting its ability to pump blood to the body normally.
Your doctor and a pediatric cardiologist can determine if the murmur is innocent (which means your child is perfectly healthy) or if there is a specific heart problem. If there is a problem, the pediatric cardiologist will know how best to take care of it.
Reviewed by: Steven B. Ritz, MD
Date reviewed: September 05, 2017