Overview
In the developing fetus, the ductus arteriosus (DA) is a shunt connecting the pulmonary artery to the aortic arch. It allows the blood from the right ventricle to bypass the lungs.
In normal newborns, the DA is closed within a few hours after birth.
In preterm newborn babies however, this blood vessel sometimes remains open and because of the pressure gradient blood flows back from the aorta to the pulmonary artery. This condition is called patent ductus arteriosus (PDA) and affects the perfusion of the lungs and other organs (brain, kidney, mesentery).
PDA has a high occurrence in premature children:
~ 1.6% of total live births are babies born at <33 WGA and 20% of these have a haemodynamically significant PDA
~ 15500 PDA cases per year in EU
Clinical signs and symptoms
While some cases of PDA are asymptomatic, common symptoms include:
1. Bouncing pulse
2. Heart murmur
Diagnosis
PDA is diagnosed using non-invasive techniques:
Electrocardiography (ECG): electrodes are used to record the electrical activity of the heart and can detect cardiac arrhythmias associated with PDA.
Chest X-ray might reveal the structure of the infant's heart and the size.
Echocardiography: sound waves are used to capture the motion of the heart. It is the main diagnostic tool in detecting PDA.
Treatments
Conservative: symptomatic supportive treatment
Medical treatment: prostaglandin synthetase inhibitors (ibuprofen, indomethacin)
Surgical treatment: ligation |
