Patent Ductus Arteriosus (PDA)

What is a Patent Ductus Arteriosus (PDA)?

In a Normal Heart of an infant inside a mother’s womb, there is a small ligamentous vessel connecting the two great vessels of the heart (the Aorta and the Pulmonary Artery). During pregnancy this vessel directs or “shunts” the blood from the Pulmonary Artery to the Aorta, subsequently bypassing the high-pressured blood vessels in the lungs. At birth when an infant draws his/her first breaths of Oxygen the blood vessels in the lungs relax and allow more and more blood to flow through them. When the pressure in the lungs falls, the shunting of the blood from the Pulmonary Artery to the Aorta decreases greatly. In response to this decrease of flow through the Ductus, the vessel begins to shrink. This connection that seems to be essential in the womb and for the first few minutes after birth will normally close itself off shortly after the infant is born.

What happens with a Patent Ductus Arteriosus/ What occurs if the Ductus does not close normally on its own and is left untreated?

Problems can arise from a patent or “open” Ductus Arteriosus. If for whatever reason the Ductus does not close off after a few days of life, a couple of risks for the patient increase. First of all with an open Ductus the risk of Endocarditis, or an infection in the heart, can increase. Secondly, if there is a large amount of blood shunting through the open Ductus the risk of Congestive Heart Failure can arise.

When should a PDA be treated?

Infants who are premature with a Patent Ductus are usually given a trial dosage of a drug that will sometimes successfully close a Ductus. This drug is called “Indomethecin”. Although this drug can succeed in closing some PDA’s it is not successful in closing all. If this medication is unsuccessful, closure of the PDA by surgical ligation is indicated in newborns who are failing to thrive or who are experiencing symptoms of Congestive Heart Failure. Although it is extremely unlikely that the Duct will close after 1 year of age, if the infant is not experiencing signs and symptoms of Congestive Heart Failure and is growing and gaining weight the duct should be given a chance to close on its own. If the duct has not closed by the patient’s 1st birthday closure should be recommended. Closure in older children has been successfully completed by a procedure in the Cardiac Catheterization Lab depending on the diameter of the vessel. Most persistent PDA’s seem to be of a larger diameter whereby an operative closure should be recommended.

What is the operative procedure to close a Patent Ductus Arteriosus?

To surgically correct a “patent” Ductus, the connection from the Aorta to the Pulmonary Artery is tied off and/or cut or “ligated”. The surgery is done through an incision in the side of the chest called a "Thoracotomy”. This is not an “Open Heart “ procedure because the heart itself does not have to be surgically entered to ligate this vessel.

Is the Surgical closure of a Patent Ductus Arteriosus a safe procedure?

No surgery is ever 100% safe, but the closure of a Patent Ductus Arteriosus is a very safe and simple procedure. The child must have general anesthetic, and must undergo a “Closed Heart” procedure. Some of these risks involve bleeding requiring a blood transfusion, infection, and of course there is still greater than 1% chance of death.

Will my child’s heart be normal after closure of the PDA?

The heart should function as a normal heart very soon after the ligation of the Ductus has taken place.

Contact Information:

John Mark Morales MD, FACS, FAAP
Chief of Cardiothoracic, Director of Perfusion Services
Certified by the American Board of Surgery, American Board of Thoracic Surgery

Mark Bielefeld, MD
Driscoll Children's Hospital Chief of Staff
Certified by the American Board of Surgery, American Board of Thoracic Surgery

Thoracic surgeons are available for questions and consultations: (361) 854-0201. For appointments, assistance, and physician references in Corpus Christi call: (361) 854-0201 or 800-DCH-LOVE
Fax : 361-855-7572
E-MAIL : jmarkmorales@aol.com

For further information on any surgical procedures you can contact Carol Kaplan, RN, Surgical Nurse Liaison at (361) 694-5150. Consultation and surgery for inpatients is provided in concert with neonatology and pediatric cardiology departments. Complete evaluation and management for infants, children, adolescents and adults with congenital or acquired cardiac, vascular or thoracic anomalies.

Cardiothoracic Associates
3533 S. Alameda, Suite 202
Corpus Christi, Texas 78411
Phone: (361) 694-5150
Fax: (361) 855-7572
Hours: 9am to 6pm
Fri 9am to 5pm