PDA (patent ductus arteriosus) 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 re-circulate through the lungs.

1. PDA (Patent Ductus Arteriosus) LIGATION –
an overview
What is a patent ductus arteriosus (PDA)?
PDA (patent ductus arteriosus) 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 re-
circulate 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.
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

2. 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:

3. • 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

4. 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

5. 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 increases 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

6. months of age. Your child's cardiologist will recommend when
the repair should be performed.
Tran catheter 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 of patent ductus arteriosus.
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.

7. • 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

8. 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.
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