What Are The Ways To Prevent Patent Ductus Arteriosus & Does It Recur?

The incidence of patent ductus arteriosus is increased by 60% in premature infants <28 weeks gestation.1

Isolated patent ductus arteriosus has an excellent prognosis.1

Patent ductus arteriosus (PDA) is a congenital heart defect in which the communication between the descending thoracic aorta and pulmonary artery persists resulting in non-closure of the fetal ductus. Although, the incidence of PDA is low in US children born at term equaling 0.02-0.006% of live births, the incidence increases in premature children by 20% in infants born >32 weeks gestation and by 60% in those born <28 weeks gestation. Incidence is also higher in low birth weight infants, children born at high altitudes, history of perinatal asphyxia, and siblings. Generally, the female to male ratio is 2:1; however, the incidence is equal in patients exposed to teratogens, such as congenital rubella.1

What Are The Ways To Prevent Patent Ductus Arteriosus And Does It Recur?

It is common for the patent ductus arteriosus to close spontaneously in infants with the functional closure of ductus arteriosus occurring within 15 hours of life in healthy infants born at term. However, anatomic closure of the ductus arteriosus takes several weeks. The patency of ductus arteriosus is maintained during fetal life as it helps in the blood flow to the fetal organs and structure during fetal development. High levels of circulating prostaglandin E2 (PGE2) in the fetal circulation helps maintain patency of ductus arteriosus during fetal development. The spontaneous closure of patent ductus arteriosus in infants >3 months is rare; however, in premature infants <3 months, spontaneous closure occurs in 72-75% of the cases. Therefore, patent ductus arteriosus is considered abnormal in infants older than 3 months, and treatment is considered at this point.1

The closure of patent ductus arteriosus is promoted by the administration of prostaglandin antagonists, such as nonsteroidal anti-inflammatory drugs indomethacin or aspirin, especially in premature infants. Pharmacological therapy with indomethacin and ibuprofen is effective in closing patent ductus arteriosus if medication is administered in the first 10-14 days of life. Indomethacin is administered at a dose of 0.1 mg/kg body weight orally every 8 hours. Ibuprofen is used at a dose of 10 mg/kg bolus followed by 5 mg/kg/d for 2 additional days. The closure rate with medical treatment is around 80-92%. Ductus arteriosus may reopen days or weeks later with prophylactic medication since the closure with medication occurs due to constriction of the ductus arteriosus.1

Cardiac catheterization is becoming the treatment of choice for the closure of patent ductus arteriosus in children and adults. Surgical ligation is the standard treatment for large PDA. Best results of surgery are achieved in patients younger than 3 years as in children older than 3 years, the incidence of elevated pulmonary vascular resistance and pulmonary hypertension increases. The survival rate reduces with the increase in the size of the ductus arteriosus with a surgical mortality rate in premature infants of around 20-41%. There are also reports of recurrence of left-to-right shunt after ligation of patent ductus arteriosus, but the risk is extremely low.1

Although patent ductus arteriosus is mostly found in children, it can be found at any age. The signs and symptoms are commonly due to the left-to-right shunt in which blood from the systemic circulation flows to the pulmonary circulation. Generally, children with patent ductus arteriosus are asymptomatic but can complain of a decrease in exercise tolerance or lung congestion along with a murmur. Infants who are 3-6 weeks old can show symptoms of increased heart rate, increased sweating, difficulty or inability to breastfeed, and weight loss or no weight gain.

In cases where there is a moderate degree of the left-to-right shunt, patients may present with cough, hoarse cry, pneumonia, atelectasis, or lower respiratory tract infections. In larger defects, there may be a history of difficulty feeding and poor growth during infancy. Adults with an undiagnosed patent ductus arteriosus may present with atrial arrhythmia, heart failure, or cyanosis limited to the lower extremities.1

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