Patent Ductus Arteriosus
Patent Ductus Arteriosus
The ductus arteriosus is a large blood vessel that connects the main pulmonary trunk (blood vessel to lungs) with the descending aorta (blood vessel to body organs). In utero, pulmonary resistance (blood pressure in lungs) remains high, as the work of lungs i.e getting oxygen from air, is done by the placenta. This resists the heart from pumping the blood into the lungs. The bulk of the right ventricular (right lower chamber of heart) output travels through the ductus arteriosus, maintaining flow in the descending aorta and to the placenta.
At delivery, a series of complex changes occur. With the first breath, the tiny blood vessels in the lungs (pulmonary capillaries) open and resistance to pulmonary blood flow drops. This allows the blood from the heart to be pumped into the lungs. At the same time, the blood pressure in the rest of the body (systemic BP) increases. As systemic pressures start to exceed pulmonary pressures, blood flow through the ductus arteriosus reverses and oxygenated blood from the systemic circulation flows into the pulmonary circulation. Final functional closure of the duct occurs by 24 hours of age in around half of healthy full-term infants but may be considerably delayed in the premature.
Presentation
- A ductus arteriosus is usually clinically silent over the first couple of days of life.
- Echocardiography may however reveal a significant left to right shunt (oxygenated blood going back to lungs).
- Continuing patency of the ductus may lead to heart failure and respiratory symptoms.
Treatment
- Clinical management of the duct is still a topic of hot debate.
- We have adopted the “targeted” approach to the duct whereby treatment is determined by early echocardiography.
Principles of Management
- Medical management NSAID such as Indomethacin, Ibuprofen & Paracetamol are commonly used.
- A repeat echocardiogram should be performed within 24 hours of the third / fifth dose depending on the drug used.
- Surgical Ligation Surgical ligation of the premature duct is only considered on a case by case basis.
Frequently Asked Questions
Find answers about Patent Ductus Arteriosus (PDA), its diagnosis and treatment for premature babies at Southern Gem Hospital in Hyderabad.
What is Patent Ductus Arteriosus (PDA)?
The ductus arteriosus is a large blood vessel that connects the main pulmonary trunk (blood vessel to the lungs) with the descending aorta (blood vessel to the body organs). In the womb, this duct is important for circulation. Normally, it closes after birth. A Patent Ductus Arteriosus (PDA) is a condition where this duct remains open after birth.
Final functional closure of the duct occurs by 24 hours of age in around half of healthy full-term infants, but may be considerably delayed in premature babies.
Why does PDA happen in premature babies?
In the womb, pulmonary resistance remains high as the work of the lungs, including getting oxygen, is performed by the placenta. The bulk of the right ventricular output travels through the ductus arteriosus.
At delivery, with the first breath, the pulmonary capillaries open and resistance drops, allowing blood to be pumped into the lungs. The duct normally closes by 24 hours in around half of full-term infants, but closure may be considerably delayed in premature babies, resulting in a Patent Ductus Arteriosus.
What are the symptoms of PDA?
A ductus arteriosus is usually clinically silent during the first couple of days of life. Echocardiography may, however, reveal a significant left-to-right shunt, where oxygenated blood goes back to the lungs.
Continuing patency of the ductus may lead to heart failure and respiratory symptoms.
How is PDA diagnosed?
PDA is diagnosed using echocardiography, which may reveal a significant left-to-right shunt. At Southern Gem Hospital, a targeted approach is adopted whereby treatment is determined by early echocardiography.
A repeat echocardiogram is performed within 24 hours of the third or fifth dose of medication, depending on the drug used.
How is PDA treated?
PDA treatment involves:
1. Medical Management: NSAIDs such as Indomethacin, Ibuprofen and Paracetamol are commonly used to help close the duct. A repeat echocardiogram is performed within 24 hours of the third or fifth dose, depending on the medication used.
2. Surgical Management: Surgical ligation of the premature duct may be considered on a case-by-case basis when required.
Southern Gem Hospital adopts a targeted approach where treatment is determined by early echocardiography.
Is surgery always needed for PDA?
No. Surgery is not always needed for PDA. Medical management using NSAIDs such as Indomethacin, Ibuprofen and Paracetamol is commonly used first to help close the duct.
Surgical ligation of the premature duct is considered on a case-by-case basis when medical management is not sufficient.
Is PDA treatment available at Southern Gem Hospital Hyderabad?
Yes. Southern Gem Hospital, Hyderabad offers targeted echocardiography-guided diagnosis and treatment of Patent Ductus Arteriosus (PDA) in its NICU at both Basheerbagh and Banjara Hills branches. Treatment is led by Dr. Nitesh Agarwal, Neonatologist.
Basheerbagh: +91 40 6658 5555
Banjara Hills: +91 91778 20007
Email:
info@southerngem.in