Patent ductus arteriosus (pda)

[Jason Yan]

Patent ductus arteriosus (PDA) is a persistence of the fetal connection (ductus arteriosus) between the aorta and pulmonary artery after birth. In the absence of other structural heart abnormalities or elevated pulmonary vascular resistance, shunting in the PDA will be left to right (from aorta to pulmonary artery). Symptoms may include failure to thrive, poor feeding, tachycardia, and tachypnea. A continuous murmur at the upper left sternal border is common. Diagnosis is by echocardiography. Administration of a cyclo-oxygenase inhibitor (ibuprofen lysine or indomethacin ) with or without fluid restriction may be tried in premature infants with a significant shunt, but this therapy is not effective in term infants or older children with PDA. If the connection persists, surgical or catheter-based correction is indicated.
(See also Overview of Congenital Cardiovascular Anomalies.)
Patent ductus arteriosus accounts for 5 to 10% of congenital heart anomalies; the male:female ratio is 1:3. PDA is very common among premature infants (present in about 45% with birth weight lt; 1750 g and in 70 to 80% with birth weight lt; 1200 g). About one third of PDAs will close spontaneously, even in extremely low birth weight infants. When persistent in premature infants, a significant PDA can result in heart failure, pulmonary hemorrhage, renal insufficiency, feeding intolerance, necrotizing enterocolitis, and even death.