Patent Ductus Arteriosus
The ductus arteriosus (DA) is a normal vessel that connects the aorta and the pulmonary artery. It is found in all babies as they develop in the uterus.
During pregnancy, blood does not circulate through the fetus' lungs. This is because oxygen is provided through the placenta. The DA allows oxygen-rich blood to flow from the pulmonary artery to the descending aorta, bypassing the lungs and proceed out to the body.
Once the child is born and the lungs begin to work, the DA normally closes on its own. This usually within 24 to 48 hours of birth. However, in some children, especially premature babies, the DA may stay open.
Concerns and Symptoms
If the DA remains open, oxygen-rich blood continues to flow from the aorta to the pulmonary artery. The heart and lungs must then handle more blood than normal. This can increase the pressure in the lung's blood vessels, a condition called pulmonary hypertension. The heart muscle may also enlarge and become less able to pump blood effectively. The child may then develop congestive heart failure.
Symptoms of PDA vary depending on the size of the ductus. If the ductus is small, the only symptom may be a heart murmur. If it is large, symptoms may include shortness of breath, difficulty feeding or poor weight gain.
In older children, most PDAs are repaired by guiding a catheter through a blood vessel up into the heart. A coil is then passed through the catheter into the PDA, thereby preventing blood from flowing through the opening. This type of procedure is performed by interventional cardiologists.
Premature infants with PDA are often first given anti-inflammatory medications to help close the opening. If this fails because of the child's small size, surgical repair is necessary. For full-term infants who are exhibiting symptoms, it is usually best to repair the PDA before six months of age.
Surgery to repair a PDA is performed under general anesthesia, which means the child will be asleep during surgery. The heart-lung bypass machine is not needed during the operation.
First, the surgeon makes an incision in the left side of the chest. He then spreads the ribs and moves the lung to the side so the PDA can be seen. The surgeon then ties off or clips the ductus. This prevents blood from flowing through the vessel, curing the disorder. The surgeon then closes the incision and applies bandages to the incision site.