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Patent ductus arteriosus (PDA) is a congenital heart defect wherein the ductus arteriosus fails

to close after birth. Early symptoms are uncommon, but in the first year of life include increased

work of breathing and poor weight gain. An uncorrected PDA may lead to congestive heartfailure with increasing age.

Signs and symptomsommon symptoms include!

"achycardia (a heart rate e#ceeding the normal resting rate)$espiratory problems

Dyspnea (shortness of breath)

ontinuous machine%like heart murmur (usually from aorta to pulmonary artery, with higher

flow during systole and lower flow during diastole)ardiomegaly (enlarged heart, reflecting ventricular dilation and volume overload)

&eft subclavicular thrill

'ounding pulse

idened pulse pressurePoor growth

Differential cyanosis, i.e. cyanosis of the lower e#tremities but not of the upper body.Patients typically present in good health, with normal respirations and heart rate. f the PDA is

moderate or large, widened pulse pressure and bounding peripheral pulses are fre*uently present,

reflecting increased left ventricular stroke volume and diastolic run%off of blood into the (initially

lower%resistance) pulmonary vascular bed. Prominent suprasternal and carotid pulsations may benoted secondary to increased left ventricular stroke volume

Cause

A PDA is sometimes idiopathic. +nown risk factors include!

Preterm birthongenital rubella syndrome

hromosomal abnormalities (e.g., Down syndrome)

enetic conditions such as &oeys%Diet- syndrome (would also present with other heart defects)

Diagnosis

Phonocardiograms from normal and abnormal heart sounds /oninvasive techni*ues

Echocardiography (in which sound waves are used to capture the motion of the heart)

Electrocardiography

A chest 0%ray may be taken, which reveals overall heart si-e (as a reflection of the combined

mass of the cardiac chambers) and the appearance of blood flow to the lungs.1mall PDA 2 normal si-ed heart and normal blood flow to the lungs

&A$E pda % enlarged cardiac silhouette and increased blood flow to the lungs.

Prevention

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indomethacin administration on the first day of life to all preterm infants reduces the risk of

developing a PDA and the complications associated with PDA.

Treatment

hile symptomatic PDA can be treated with both surgical and non%surgical methods.

1urgically, the DA may be closed by ligation (though support in premature infants is mi#ed),either manually tied shut, or with intravascular coils or plugs that leads to formation of a

thrombus in the DA.

PDAs can be closed by percutaneous interventional method (avoiding open heart surgery). A

 platinum coil can be deployed via a catheter through the femoral vein or femoral artery, which

induces thrombosis (coil emboli-ation). Alternatively, a PDA occluder device, composed of

nitinol mesh, is deployed from the pulmonary artery through the PDA.