Is Patent Ductus Arteriosus A Progressive Disease & Alternative Treatments For It?

Spontaneous closure of PDA is rare in full-term babies after 5 months, the condition left untreated may require lung transplantation for the long-time survival.1,2

There is no cure for patent ductus arteriosus however medications and other treatment options may be helpful to close PDA.3

PDA usually closes on its own but when there is a respiratory problem or impaired oxygen delivery is present, therapy is very effective.4

Is Patent Ductus Arteriosus A Progressive Disease?

A small patent ductus arteriosus may close as the child grows. However, in some cases, it may show signs and symptoms and the infant may require to be treated with medicine, cardiac catheterization, or surgery. The cardiologist will do a watchful waiting from time to time to determine if the PDA is closing on its own. The condition that remains open will need to be filled to prevent lung infections and cardiovascular failures.

Spontaneous closure in full-term infants occurs in a few hours or 2 days after birth and it is rare when it exceeds 5 months or more. When the condition is left untreated the patients have an increased risk of developing Eisenmenger syndrome (a pulmonary vascular obstructive disease wherein the pressure in the pulmonary artery elevates resulting in cyanosis).

The condition becomes irreversible after a certain period and the closure of PDA becomes contraindicated. During this instance, lung transplantation is the only mode of treatment to extend the survivability of the affected patient.1,2

Alternative Treatments For Patent Ductus Arteriosus

Closure of patent ductus arteriosus is quite common in newborns so your child’s cardiologist may allow more time to see if it closes on its own. However, when there is significant respiratory distress or impaired systemic oxygen delivery is present, you may require seeking immediate medical attention for proper treatment.

Medications that include Intravenous (IV) indomethacin (or the newer preparation of IV ibuprofen) is the most common and effective treatment in closing the patent ductus arteriosus in the first 2 weeks after birth. When medicines don’t provide effective solutions Cardiac Catheterization procedure is used.3

This is an invasive imaging procedure that cardiologists, or heart specialists, use to evaluate heart function and the only way to directly measure the pressure of blood in each chamber of the heart and the major blood vessels.

During the procedure, the child is sedated and inserted with a small thin tube called a catheter into the heart through the blood vessels. Followed by that, a special device called coil or occlude is placed to prevent the blood from flowing through it. The coil is applicable only when the PDA is smaller however for larger patent ductus arteriosus a plug-shaped device is used to block the vessel.4

Patent ductus arteriosus (PDA) is a relatively common congenital heart defect noticed more often in premature infants on an average of 8 in 1000 births and full-term babies at an average of 2 in 1000 births.

Smaller patent ductus arteriosus does not cause symptoms however larger defects or complications such as heart failure, arrhythmias, or pulmonary hypertension are noticed in ductus left untreated and remain open. When the gestating mothers have Eisenmenger syndrome, pregnancy should be avoided as it causes fetal death and turns life-threatening for pregnant mothers.

References:

  1. Baffa, Jeanne Marie, et al. “Patent Ductus Arteriosus (PDA) – Pediatrics.” Merck Manuals Professional Edition, Merck Manuals, www.merckmanuals.com/en-ca/professional/pediatrics/congenital-cardiovascular-anomalies/patent-ductus-arteriosus-pda.
  2. Wiyono, S A, et al. “Patent Ductus Arteriosus in Adults: Case Report and Review Illustrating the Spectrum of the Disease.” Netherlands Heart Journal : Monthly Journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation, Bohn Stafleu Van Loghum, Aug. 2008, www.ncbi.nlm.nih.gov/pmc/articles/PMC2516289/.
  3. “Patent Ductus Arteriosus (PDA).” Mayo Clinic, Mayo Foundation for Medical Education and Research, 25 Jan. 2018, www.mayoclinic.org/diseases-conditions/patent-ductus-arteriosus/diagnosis-treatment/drc-20376150.
  4. Luke K Kim, MD. Patent Ductus Arteriosus (PDA) Treatment & Management: Approach Considerations, Conservative Management, Pharmacologic Management, Medscape, 23 Mar. 2020, emedicine.medscape.com/article/891096-treatment.

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